tailieunhanh - Vascular Surgery - part 4

Các động mạch đùi (hình 30,1), tiếp tục trực tiếp của động mạch chậu bên ngoài, vào đùi phía sau dây chằng bẹn (dây chằng Poupart của) nằm giữa cột sống chậu trước cấp trên và củ mu. Từ thời điểm này, động mạch sau một khóa học gần như thẳng, dần dần inclining từ trước đến khía cạnh | CHAPTER 30 The Lower Extremity Henry Haimovici Femoral Artery Anatomic Review The femoral artery Fig. a direct continuation of the external iliac artery enters the thigh behind the inguinal ligament Poupart s ligament midway between the anterior superior iliac spine and the pubic tubercle. From this point the artery follows an almost straight course gradually inclining from the anterior to the posteromedial aspect of the thigh. As a result of this direction the initial segment of the femoral artery is comparatively superficial but its terminal portion becomes deeply located. In its proximal part it is located in what is known anatomically as the femoral triangle or the triangle of Scarpa. In its distal portion it is located in an anatomic area known as the adductor or Hunter s canal. The anatomic landmarks of Scarpa s triangle include the soft parts of the root of the thigh. This region is bounded proximally by the inguinal ligament laterally by the Sartorius muscle and medially by the pectineus and adductor muscles. Distally the apex of the triangle is formed by the overlapping of these muscles. The roof of this area consists of the fascia lata which completely covers the space anteriorly. The floor is made up of two inclined planes which form a well-marked medium groove at their junction. The laterally inclined plane consists of the iliopsoas muscle invested by a thin layer of fascia. In this compartment are included the femoral vessels and nerve and their large branches. Among the latter structures are the termination of the great saphenous vein and the deep sub-inguinal lymph vessels and glands embedded in a quantity of loose fat tissue. This space communicates with the abdomen through the lacuna vasorum. 354 Exposure of Femoral Artery in Scarpa s Triangle The patient is placed in the supine position with the thigh in abduction and slight external rotation. A curved skin incision is made extending from above the inguinal ligament and with a concavity .