The terminal branches of the popliteal artery are. Popliteal artery, its topography and branches

A popliteal artery aneurysm is an abnormal enlargement of the main artery that runs from the lower third of the thigh to the upper third of the leg. It is located quite deep in the leg below the knee. The popliteal artery is a continuation of the superficial femoral artery and divides below the knee into the anterior, posterior tibial arteries, and peroneal artery. These arteries supply blood to the lower leg and foot, so blocking the blood flow in the popliteal artery leads to severe circulatory failure in the leg below the knee. The normal vessel diameter is about 6-10 mm.

Popliteal aneurysm is a risk factor for sudden acute limb ischemia and subsequent amputation. Unoperated aneurysms lead to amputation of the leg in 50% of all cases in 3 years.

A popliteal artery aneurysm should be operated on as soon as possible after diagnosis. Don't expect it to "resolve" by itself. The high risk of acute ischemia and the good results of elective surgery should encourage the patient to agree to surgery. The results of planned interventions are very good.

Treatment technologies at the Innovative Vascular Center

Vascular surgeons of our clinic have significant experience in diagnosing and treating both planned and complicated lesions of the popliteal arteries. The main method of treatment in our clinic is autovenous prosthetics of the popliteal aneurysm. This technology shows the best immediate and long-term results. With complicated aneurysms, open surgery allows you to restore the patency of not only the popliteal artery, but also the vessels of the lower leg. Endovascular interventions with extensions of this localization have very poor results due to the high mobility of the knee joint.

The reasons

Popliteal artery aneurysms account for about 1% of all surgical vascular diseases and often occur in both legs. The main reason is the congenital weakness of the arterial wall, which contributes to their pathological expansion. The majority of patients (95%) are elderly men with a mean age of about 71 years. The exact reasons for the development of expansion in the popliteal artery are unknown, but there is a clear connection with atherosclerotic changes in the vessel wall, sometimes the pathology develops as a result of injuries of the popliteal region, dislocations or fractures. Patients with multiple aneurysms in different arteries should have general tissue weakness. The exact nature of this has not yet been elucidated. The tendency of the popliteal artery to pathological expansion is associated with frequent flexion and extension of the vessel due to movements in the knee joint.

Complaints and symptoms

Patients with an aneurysm complain of a feeling of heaviness in the popliteal region, swelling of the foot of the affected limb, and sometimes shooting pains. Most often, such complaints are vague and the patient may not be aware that he has such a dangerous disease.

With aneurysm thrombosis, a clinical picture of acute ischemia develops - severe pain in the affected limb, discoloration and skin temperature of the foot. Subsequently, a violation of sensitivity and movement develops. With advanced acute ischemia, stiffness of the lower leg and foot develops, active and passive movements are impossible due to muscle death.

Course and complications

The main risk from a popliteal aneurysm is associated with embolization - blockage of the underlying arteries with pieces of blood clots or occlusion of the aneurysm cavity. Both of these complications can lead to acute ischemia and gangrene of the legs (sudden loss of blood supply). Blood clots (thrombi) gradually form in the cavity of the vessel. When this clot remains attached to the vessel wall, it does not pose any danger. If a fragment of a blood clot breaks off, it can travel far from the aneurysm and cause blockages in small arteries, preventing blood flow to downstream tissues.
A popliteal aneurysm can burst (rupture), but this is much less common than embolization. In this case, a pulsating hematoma occurs behind the knee. Simultaneously with the rupture, the next stage is thrombosis of the popliteal artery with the development of signs of acute circulatory failure of the limb. Most people develop severe ischemic changes and death of the leg. Only an operation performed within the next 6-12 hours after the complication will help to avoid amputation.

Forecast

It is the complications of an aneurysm that are the main reason for the most urgent intervention. In the group of patients with aneurysm, the probability of thrombosis and acute ischemia with loss of a limb is 20% per year. Ignorance of one's pathology and false hopes for chance lead to the development of severe complications.

Elective surgeries are successful in 100% of patients and their effectiveness remains for many years.

After surgical treatment of a popliteal aneurysm, recovery usually occurs. In operations for complications, the result of treatment depends on the urgency of the intervention. If the operation is performed in the first 6 hours from the onset of the disease, then the leg can be saved in 80% of patients; after 24 hours, only amputation is the only way out.

Popliteal artery (a. poplitea). Branches of the popliteal artery.

A. poplitea, the popliteal artery, is a direct continuation of the femoral artery. In the popliteal fossa a. poplitea is located on the bone itself (where it can be pressed against the bone with a half-bent position of the limb) and the posterior surface of the articular capsule anteriorly and somewhat medially from v. poplitea; further down the artery lies on the back surface of m. popliteus covered with m. gastrocnemius, and then, going under the edge of m. soleus, is divided into two of its terminal branches (aa. tibiales anterior et posterior).

Branches of the popliteal artery, a. poplitea:

1. Ah. genus superiores lateralis et medialis, superior genicular arteries, lateral and medial, depart at the level of the upper edge of the femoral condyles; each bend around the knee joint from its side, pass to its front surface, where, entering into the anastomosis between themselves, they participate in the formation of the arterial network of the knee joint (rete articulare genus).

2. Ah. genus inferiores lateralis et medialis, the lower knee arteries, lateral and medial, branch in the area of ​​the knee joint similarly to the upper arteries, but depart from a. poplitea at the level of the lower edge of the femoral condyles.

3. A. genus media, the middle knee artery, leaves in the middle between the upper and lower arteries of the knee joint, pierces the articular capsule and branches in the cruciate ligaments.

Anterior tibial artery (a. tibialis anterior). Branches of the anterior tibial artery.

A. tibialis anterior, the anterior tibial artery, is one of the two terminal branches of the popliteal artery (smaller in caliber). Immediately after the start, it pierces the deep muscles of the flexor surface of the leg and through the hole in the interosseous membrane goes into the anterior region of the leg, passes between m. tibialis anterior and m. extensor digitorum longus, and below lies between m. tibialis anterior and m. extensor hallucis longus. Above the ankle joint, it passes superficially, covered by skin and fascia; its continuation on the back of the foot is called a. dorsalis pedis.

Branches of the anterior tibial artery, a. tibialis anterior:

1. A. recurrens tibialis posterior, posterior recurrent tibial artery (to the opening), to the knee joint and to the joint between the fibula and tibial bones.

2. A. recurrens tibialis anterior, the anterior recurrent tibial artery (after the opening), goes to the lateral edge of the patella, participating in the formation of the rete articulare genus.

3. Ah. malleolares anteriores medialis et lateralis, the anterior ankle arteries, lateral and medial, are involved in the formation of rete malleolare mediale et laterale.

Posterior tibial artery (a. tibialis posterior). Branches of the posterior tibial artery.

A. tibialis posterior, the posterior tibial artery, is, as it were, a continuation of the popliteal artery. Going down the canalis cruropopliteus, on the border of the middle third of the lower leg from the bottom, it comes out from under the medial edge of m. solei and becomes more superficial. In the lower third of the leg a. tibialis posterior lies between m. flexor digitorum longus and m. flexor hallucis longus, medially from the Achilles tendon, covered here only by skin and fascial sheets. Bypassing the medial malleolus behind, it is divided on the sole into its two terminal branches: aa. plantares medialis et lateralis. Pulse a. tibialis posterior is palpated by pressing it against the medial malleolus.

Rice. 793. Arteries of the gluteus medius, right (X-ray photograph. Preparation by N. Rybakina). (The largest vessels in the thickness of the muscle are presented.)

Popliteal artery, a. poplitea (Fig.,,,; see Fig.,,), is a direct continuation of the femoral artery. It starts at the level of the lower opening of the afferent canal, lies under the semimembranosus muscle and goes along the bottom of the popliteal fossa, adjoining first to the popliteal surface of the femur and then to the articular capsule of the knee joint, and in its lower section to the popliteal muscle. The popliteal artery has a direction first downward and somewhat laterally, and from the middle of the popliteal fossa it is almost vertical.

The lower part of the artery passes into the gap between the heads of the gastrocnemius muscle covering it, and at the level of the lower edge of the popliteal muscle, the artery follows between it and the heads of the gastrocnemius muscle; under the edge of the soleus muscle is divided into the posterior tibial artery, a. tibialis posterior, and anterior tibial artery, a. tibialis anterior.

The popliteal artery is accompanied throughout the entire length by the vein of the same name and the tibial nerve, n. tibialis. On the side of the popliteal fossa, behind, the vein lies superficially, and the nerve is even more superficial in relation to the artery and vein.

In its course, the popliteal artery gives a number of branches that supply blood to the muscles and the knee joint. All these branches anastomose widely among themselves, as well as with rr. perforantes (branches a. profunda femoris) and a. descendens genicularis (branch a. femoralis), forming a dense vascular knee joint network (see Fig.).

A number of branches depart from the popliteal artery (see Fig.,).

1. Lateral superior genicular artery, a. superior lateralis genus, goes outwards under the biceps femoris and, heading over the lateral condyle, breaks up into smaller branches that take part in the formation of the knee articular network.
2. Medial superior genicular artery, a. superior medialis genus, goes anteriorly under the tendons of the semimembranosus and large adductor muscles, above the medial condyle and, bending around the femur from the inside, takes part in the formation of the knee articular network.
3. Middle genicular artery, a. media genus, goes anteriorly from the popliteal artery, pierces the capsule of the knee joint above the oblique popliteal ligament and gives a number of branches to the synovial membrane of the joint and the cruciate ligaments.
4. Lateral inferior genicular artery, a. inferior lateralis genus, starts from the most distal part of the popliteal artery, passes under the lateral head of the gastrocnemius muscle and the biceps femoris, goes around the knee joint above the head of the fibula and, having reached the anterior surface of the knee, takes part in the formation of the knee articular network.
5. Medial inferior genicular artery, a. inferior medialis genus, passes under the medial head of the gastrocnemius muscle and goes around the medial periphery of the knee joint, lying under the tibial collateral ligament. The branches of the artery are part of the network of the knee joint.
6. Sural arteries, aa. naturales, only two (sometimes more), depart from the posterior surface of the popliteal artery and, breaking up into a number of smaller branches, supply blood to the proximal sections of the triceps and plantar muscles of the lower leg and the skin of the lower leg.

popliteal artery,a. poplitea (Fig. 64), is a continuation of the femoral artery. At the level of the lower edge of the popliteal muscle, it divides into its terminal branches - the anterior and posterior tibial arteries. Branches of the popliteal artery:

1 Lateral superior genicular artery a. genus superior lateralis [ a. superior lateralis genus], departs above the lateral condyle of the femur, bends around it, supplies blood to the wide and biceps muscles of the thigh and anastomoses with other knee arteries, participating in the formation of the knee articular network that feeds the knee joint.

2 Medial superior genicular artery a. genus superior medialis [ a. superior medialis genus], departs from the popliteal artery at the same level as the previous one, goes around the medial condyle of the femur, supplies blood to the medial broad muscle of the thigh.

3 Middle knee artery, a. media genus, passes to the back wall of the capsule of the knee joint, to its cruciate ligaments and menisci, supplies them with blood and the synovial folds of the capsule.

4 Lateral inferior genicular artery, a. genus inferior lateralis [ a. inferior lateralis genus], departs from the popliteal artery 3-4 cm distal to the superior lateral genicular artery, goes around the lateral condyle of the tibia, supplies blood to the lateral head of the gastrocnemius muscle and plantar muscle.

5 Medial inferior genicular artery, a. genus inferior medialis [ a. inferior medialis genus], originates at the level of the previous one, goes around the medial condyle of the tibia, supplies blood to the medial head of the gastrocnemius muscle and also participates in the formation knee joint network,rete articuldre genus.

108. Leg arteries: topography, branches and areas supplied by them. Ankle blood supply.

posterior tibial artery,a. tibidlis posterior, serves as a continuation of the popliteal artery, passes in the ankle-patellar canal, which leaves under the medial edge of the soleus muscle. Then the artery deviates to the medial side, goes to the medial malleolus, behind which it passes to the sole in a separate fibrous canal under the flexor tendon retinaculum. In this place, the posterior tibial artery is covered only by fascia and skin.

Branches of the posterior tibial artery:

1. Muscular branches,rr. musculares, - to the muscles of the lower leg;

2. Branch that circumflexes the fibulaG.circumflexus fibuldris, departs from the posterior tibial artery at its very beginning, goes to the head of the fibula, supplies blood to nearby muscles and anastomoses with the knee arteries.

3. peroneal artery,a. regopea [fibuldris], follows laterally, under the long flexor of the big toe (adjacent to the fibula), then down and penetrates into the inferior musculoperoneal canal. Passing along the posterior surface between the bone membrane of the lower leg, it supplies blood to the triceps muscle of the lower leg, the long and short peroneal muscles and, behind the lateral malleolus, the fibula is divided into its terminal branches: lateral ankle branches,rr. malleolares laterales, and heel branches,rr. calcdnei, involved in education heel network,rete calcaneum. Also depart from the peroneal artery perforating branch, Mr.perforans, anastomosing with the lateral anterior ankle artery (from the anterior tibial artery), and connecting branch, g.municans, connects the peroneal artery with the posterior tibial artery in the lower third of the leg.

4medial plantar artery,a. plantdris medialis (Fig. 65), - one of the terminal branches of the posterior tibial artery. Passes under the muscle that removes the big toe, lies in the medial groove of the sole, where it is divided into superficial and deep branches,rr. superficialis et profundus. The superficial branch feeds the muscle that removes the big toe, and the deep branch feeds the same muscle and the short flexor of the fingers. The medial plantar artery anastomoses with the first dorsal metatarsal artery.

5lateral plantar artery,a. plantdris lateralis, larger than the previous one, runs in the lateral groove of the sole to the base of the fifth metatarsal bone, bends in the medial direction and forms at the level of the base of the metatarsal bones [deep] plantar arch,drcus plantdris [ profundus] (see fig. 71). The arc ends at the lateral edge of the I metatarsal bone with an anastomosis with the deep plantar artery - a branch of the dorsal artery of the foot, as well as with the medial plantar artery. The lateral plantar artery gives off branches to the muscles, bones, and ligaments of the foot.

Four plantar metatarsal arteries, aa.metatdrsales plants I-IV. Perforating branches of the dorsal metatarsal arteries flow into these arteries in the interosseous spaces. The plantar metatarsal arteries, in turn, give perforating branches,rr. perfordntes, to the dorsal metatarsal arteries.

Each plantar metatarsal artery passes into common plantar digital artery,a. digitalis plantdris com- munis. At the level of the main phalanges of the fingers, each common plantar digital artery (except the first) is divided into two own plantar digital arteries, aa.digits plan­ tdres propriae. The first common plantar digital artery branches into three own plantar digital arteries: to the two sides of the thumb and to the medial side of the II finger, and the second, third and fourth arteries supply blood to the sides of the II, III, IV and V fingers facing each other. At the level of the heads of the metatarsal bones, perforating branches are separated from the common plantar digital arteries to the dorsal digital arteries.

Anterior tibial artery,a. tibialis anterior, departs from the popliteal artery in the popliteal fossa (at the lower edge of the popliteal muscle), enters the ankle-popliteal canal and immediately leaves it through the anterior opening in the upper part of the interosseous membrane of the leg. Then the artery descends along the front surface of the membrane down and continues to the foot as the dorsal artery of the foot (Fig. 66).

Branches of the anterior tibial artery:

1muscle branches,rr. musculares, to the muscles of the leg.

2Posterior tibial recurrent artery,a. hesig-rens tibialis posterior, departs within the popliteal fossa, anastomoses with the medial inferior genicular artery, participates in the formation of the knee articular network, supplies the knee joint and the popliteal muscle.

3Anterior tibial recurrent artery,a. hesig-rens tibialis anterior, originates from the anterior tibial artery as it enters the anterior surface of the lower leg, goes up and anastomoses with the arteries that form the knee articular network. It takes part in the blood supply of the knee and tibiofibular joints, as well as the anterior tibial muscle and the long extensor of the fingers.

4Lateral anterior ankle artery,a. malleold- ris anterior lateralis, starts above the lateral malleolus, supplies blood to the lateral malleolus, ankle joint and tarsal bones, takes part in the formation lateral malleolus network,rete malleoldre later, anastomoses with the lateral ankle branches (from the peroneal artery).

5medial anterior malleolar artery,a. malleold- ris anterior medidlis, departs from the anterior tibial artery at the level of the previous one, sends branches to the capsule of the ankle joint and anastomoses with the medial ankle branches (from the posterior tibial artery), participates in the formation of the medial ankle network.

6Dorsal artery of the foot,a. dorsdlis pedis (continuation of the anterior tibial artery), goes anterior to the ankle joint between the tendons of the long extensor of the fingers in a separate fibrous canal. At this point, the artery lies under the skin and is available to determine the pulse. On the back of the foot, it goes to the first interosseous space, where it is divided into terminal branches: 1) the first dorsal metatarsal artery, a. metatarsdlis dorsdlis I, from which three digits dorsdles, to both sides of the back surface of the thumb and the medial side of the second finger; 2) deep plantar branch [artery], a. plantdris profunda, which passes through the first intermetatarsal space to the sole, perforating the first dorsal interosseous muscle, and anastomoses with the plantar arch. The dorsal artery of the foot also gives off the pre-metatarsal arteries - lateral and medial, aa.tarsles laterlis et medidlis, to the lateral and medial edges of the foot and the arcuate artery, a. ag-cuda, located at the level of the metatarsophalangeal joints and anastomosing with the lateral metatarsal artery. I-IV depart from the arcuate artery towards the fingers dorsal metatarsal arteries, aa.metatdrsales dorsdles I-IV (see Fig. 66), each of which at the beginning of the interdigital space is divided into two dorsal digital arteries, aa.digits dor­ sdles, towards the backs of adjacent fingers. Perforating branches depart from each of the dorsal digital arteries through the intermetatarsal spaces to the plantar metatarsal arteries.

The arteries of the pelvis and lower extremity are characterized by the presence of anastomoses between the branches of the iliac, femoral, popliteal, and tibial arteries, which provide collateral arterial blood flow and blood supply to the joints (Table 5). On the plantar surface of the foot, as a result of anastomosis of the arteries, there are two arterial arches. One of them - the plantar arch - lies in a horizontal plane. It is formed by the terminal section of the lateral plantar artery and the medial plantar artery (both from the posterior tibial artery). The second arc is located in the vertical plane; it is formed by an anastomosis between the deep plantar arch and the deep plantar artery, a branch of the dorsal artery of the foot. The presence of these anastomoses ensures the passage of blood to the fingers in any position of the foot.

The heart and blood vessels work normally when all arteries are in a healthy state. They entangle human organs with their networks and solve one problem - to ensure the long work of the heart and the body as a whole.

The arterial network of the knee joint can withstand intense blood flow, so it must be strong and reliable. The work of the legs, spine, organs connected with the legs through networks depends on blood circulation. Slowing the flow of blood in the artery or its blockage by blood clots, fat bubbles, cause diseases.

Functional purpose of the network of arteries under the knee

Arteries of the lower limbs

In the circulatory system, the popliteal artery continues the network of arteries of the thigh, which under the knee is divided into the final branches - the anterior and posterior vessels. This is how the knee arterial network is formed, braiding the lower leg and foot.

Functions of the arteries:

• The lateral upper one solves the problem of blood supply to the thigh muscles: wide and biceps.
• The medial upper blood supply to the thigh muscle, which is called wide in the topography of the arterial network, is located closer to the median plane of the leg.
• The middle one solves the problem of blood supply to the ligaments, menisci, synovia, and the capsular component.
• The lateral inferior provides blood supply to the calf and plantar muscles.
• The medial lower one supplies blood to the gastrocnemius muscles, is an integral part of the branches of the popliteal artery.
• The posterior tibial continues the anatomy of the popliteal artery, is located in a special canal under the knee, where the arteries and veins go, and supplies blood to the muscles of the lower leg.

Branches of the arteries of the tibial network under the leg:

• Branches of muscles directed to the ankle.
• A branch around the fibula supplies blood to adjacent muscles.
• The peroneal vessels supply blood to the triceps, long and short muscles. Here the network is distributed into terminal branches running along the ankle and heel and braiding the heel.
• The medial plantar branches into superficial and deep vessels. The superficial network entangles the muscle that leads the big toe, the deep one also nourishes the short muscles that bend the fingers.
• The lateral plantar on the topography looks like an arch of the sole, extending into the base of the metatarsal bones. Branches entangle the muscles, bones, ligaments of the foot.

Thus, full blood supply to all parts of the lower leg is ensured. This is important for normal functioning and withstanding the load that falls on the legs during the day. The knee is powered by a network of blood vessels that branches off from the anterior tibial artery.

Collaterals in the structure of the knee joint

The collateral connection in the circulatory system under the knees is a special network that has a complex structure in supplying blood to the leg from the knee to the foot. The arteries of the popliteal destination depart from the condyles of the thigh to the knee joint and pass into its upper blood vessels. Branching in front on the surface of the leg makes an anastomosis with the vessels on the lower leg and their branches.

The scheme of collateral connections in the structure of the knee joint includes anastomosis of the lower arteries - paired vessels extending from the popliteal arteries to the upper paired vessels - they make up the arterial network. The structure of the network in its distal part necessarily includes the arteries of the lower leg, which give off a recurrent branch, which is connected to a permanent recurrent artery.

When it is required to ligate the popliteal artery, the collateral network is the connection of the vessels of the thigh and lower leg. The artificial creation of blood circulation in a collateral way distributes off branches if it is required by treatment after a disease or injury.

The arterial component of the blood supply

The blood supply to the knee joints is provided by arterial networks that are parallel on both legs. A special task is solved by the middle artery of the knee, which is set to nourish the internal structures of the joint - menisci, synovial tissues, cruciate ligaments.

Descending arteries stretch to the knee vessels from the femoral ones, and two recurrent arteries from the tibial ones. The outflow of blood is provided by veins with the same names. All of them are topographically located in such areas of the joint capsule, where the least pressure is provided, so that the blood supply in both directions is carried out at a normal speed.

The function of the legs depends on the normal functions and integrity of the network of the popliteal arteries. If, as a result of a knee injury, an artery rupture occurs, open or closed, it is accompanied by hemorrhage, which cuts off the nutrition of all leg muscles, all structures of the knee joint. If a hematoma appears on the knee, pain and limping, you should consult a doctor.

Simple research methods are used - external determination of gait, examination of the knee in the patient's supine position, palpation of the knee joint, determination of the state of the subcutaneous vascular network. On palpation of the hematoma, its depth is determined, the possibility of penetration into the internal structures of the knee.

Violation of blood supply due to injuries or diseases leads to atrophy of the muscles of the thigh, lower leg, foot. This is determined visually and by measuring the topography of the movements of the knee.

Treatment of pathologies of the arterial system

Damage is the most common form of pathology of the circulatory system of the legs. These are open cuts, tissue tears as a result of serious injuries, or closed injuries from blows, bruises, sprains. Knee bruises are accompanied by internal hemorrhage, damage to paraarticular tissues.

Home treatment for minor injuries: apply a pressure bandage, apply a cold compress, relieve the sore leg as much as possible. After 2-3 days, you can put warm compresses, take warm baths, UHF procedures, exercise therapy.

In the course of hemarthrosis, hemorrhage occurs in the internal cavity of the joint, the synovial membrane is damaged, and its vessels are torn. A puncture is required to remove blood from the internal space of the joint and the introduction of 2% novocaine solution into 20 ml. After that, a plaster splint is applied to the sore leg for a week. Next, the doctor prescribes UHF, electrophoresis, exercise therapy. Restoration of the functions of the circulatory system occurs within a month.