This ppt will give you the basic knowledge about the Blood Supply, Venous Drainage and Lymphatic Drainage of Lower Limb

1. Blood Supply and Lymphatic
Drainage of Lower Limb
By:
HERMIZAN BIN HALIHANAFIAH

2. ARTERIES OF THE PELVIS & LOWER LIMBS
The abdominal aorta ends by dividing into the right
and left common iliac arteries.
Then divide into the internal and external iliac
arteries.
The external iliac become the femoral arteries in the
thighs, the popliteal arteries posterior to the knee
and the anterior and posterior tibial arteries in the
legs.

3. Arteries of the Lower Limb
Branches to the lower limb arise from external iliac branch
of the common iliac artery

5. COMMON ILIAC ARTERIES
At about the level of the fourth lumbar vertebra,
the abdominal aorta divides into the right and
left common iliac arteries, the terminal branches
of the abdominal aorta.
Each passes inferiorly about 5 cm and gives rise
to two branches : internal iliac & external iliac
arteries.
The general distribution of the common iliac
arteries is to the pelvis, external genital and
lower limbs.

7. Internal iliac arteries
The internal iliac (hypogastric) arteries are the
primary arteries of the pelvis.
Begin at the bifurcation (division into 2
branches) of the common iliac arteries anterior to
the sacroiliac joint at the level of the lumbosacral
intelvertebral disc.
They pass posteromedially as they descend in
the pelvis and divide into anterior and posterior
divisions.
The general distribution of the internal iliac
arteries is to the pelvis, buttocks, external
genitals & thigh.

8. External iliac arteries
Are larger than the internal iliac arteries. They begin
at the bifurcation of the common iliac arteries.
They descend along the medial border of psoas
major muscles following the pelvis brim, pass
posterior to the midportion of the inguinal
ligaments, and become the femoral arteries.
The general distribution of the external iliac arteries
is to the lower limbs.
Branches of the external iliac arteries supply the
muscles of the anterior abdominal wall, the
cremaster muscle in males and the round ligament
of the uterus in females and the lower limbs.

9. Femoral arteries
Descend along the anteromedial aspects of the
thigh to the junction of the middle and lower
third of the thighs.
Here they pass through an opening in the
tendon of the adductor magnus muscle, they
emerge posterior to the femurs as the popliteal
arteries.
A pulse may be felt in the femoral artery where
just inferior to the inguinal ligament.
The femoral artery along with the femoral vein
and nerve and deep inguinal lymph nodes are
located in the femoral triangle.

10. Femoral arteries
The general distribution of the femoral arteries is
to the lower abdominal wall, groin, external
genitals and muscles of the thigh : quadriceps
femoris, adductors, and hamstrings.

11. Popliteal arteries
Are the continuation of the femoral arteries
through the popliteal fossa.
They descend to the inferior border of the
popliteus muscles, where they divide into the
anterior and posterior arteries. A pulse may be
detected in the popliteal arteries.
Supply the adductor magnus and hamstring
muscles and the skin on the posterior aspect of
the legs. Also supply the gastrocnemius, solues,
and plantaris muscles of the calf, knee joint,
femur, patella and fibula.

12. Anterior tibial arteries
Descend from the bifurcation of the popliteal
arteries. They are smaller than the posterior tibial
arteries.
The anterior tibial arteries descend through the
anterior muscular compartment of the leg. They
pass through the interosseous membrane that
connect tibia and fibula, lateral to the tibia.
Also supply the knee joints, anterior
compartment muscles of the legs, skin over the
anterior aspect of the legs and ankle joints.

13. Anterior tibial arteries
At the ankle, the anterior tibial arteries become
the dorsal arteries of the foot (dorsalis pedis
arteries).
A pulse in the artery may be taken to evaluate
the peripheral vascular system.
The dorsal arteries of the foot supply the
muscles, skin and joints on the dorsal aspect of
the feet.

14. Anterior tibial arteries
On the dorsum of the feet, the dorsal arteries of
the foot give off a transverse branch at the first
(medial) cuneiform bone called the arcuate
arteries that run laterally over the bases of the
metatarsals.
From the arcuate arteries branch the dorsal
metatarsal arteries, which supply the feet.
The dorsal metatarsal arteries terminate by
dividing into dorsal digital arteries, which
supply the toes.

15. Posterior tibial arteries
The direct continuation of the popliteal arteries,
descend from the bifurcation of the popliteal
arteries.
They pass down the posterior muscular
compartment of the legs posterior to the medial
malleolus of the tibia. They terminate by
dividing into the medial and lateral plantar
arteries.
Their general distribution is to the muscles,
bones and joints of the leg and foot.

16. Posterior tibial arteries
Major branches of the posterior tibial arteries are
the fibular (peroneal) arteries, which supply the
fibularis, solues, tibialis posterior and flexor
hallucis muscles.
They also supply the fibula, tarsus and lateral
aspect of the heel.
The bifurcation of the posterior tibial arteries
into the medial and lateral plantar arteries occurs
deep to the flexor retinaculum on the medial side
of the feet.

17. Posterior tibial arteries
The medial plantar arteries supply the abductor
hallucis and flexor digitorum brevis muscles and
the toes.
The lateral plantar arteries unite with a branch
of the dorsal arteries of the foot to form the
plantar arch. The arch begins at the base of the
fifth metatarsal and extends medially across the
metacarpals.
As the arch crosses the foot, it gives off plantar
metatarsal arteries, which supply the feet.
These terminate by dividing into plantar digital
arteries, which supply the toes.

23. Abdominal aorta
Left
common
iliac
Right
common
iliac
Right internal
iliac
Right external
iliac
Right femoral
Right popliteal
Right deep artery of the tigh (deep peroneal)

24. Right popliteal
Right posterior tibialRight anterior tibial
Right dorsal artery of the
foot (dorsalis pedis)
Right arcuate
Right dorsal
metatarsal
Right dorsal
digital
Right plantar
metatarsal
Right plantar
arch
Right lateral
plantar
Right plantar
digital
Right medial
plantar
Right fibular (peroneal)

25. Arterial Pressure Points
Some major arteries close to surface -- allows palpation
for pulse and serve as pressure points to reduce arterial
bleeding

31. VEINS OF THE LOWER LIMBS
Blood from the lower limbs is drained by both
superficial and deep veins.
The superficial veins often anastomose with one
another and with deep veins along their length.
Deep veins have the same names as corresponding
arteries.
All veins of the lower limbs have valves, which are
more numerous than in veins of the upper limbs.

32. Major Systemic Veins
Deep veins run parallel to arteries while superficial
veins have many anastomoses

33. SUPERFICIAL VEINS
Great
saphenous
veins
Small
saphenous
veins

35. Great (long) saphenous veins
the longest veins in the body, ascend from the
foot the groin in the subcutaneous layer.
Begin at the medial end of the dorsal venous
arches of the foot.
The dorsal venous arches are networks of veins
on the dorsum of the foot formed by the dorsal
digital veins, which collect blood from the toes
and then unite in pairs to form the dorsal
metatarsal veins, which parallel the metatarsals.

36. Great (long) saphenous veins
As the dorsal metatarsal veins approach the foot,
they combine to form the dorsal venous arches.
The great saphenous veins pass anterior to the
medial malleolus of the tibia and then superiorly
along the medial aspect of the leg and thigh just
deep to the skin.
They receives tributaries from superficial tissues
and connect with the deep veins as well.
They empty into the femoral veins at the groin.
Drain mainly the medial side of the leg and
thigh, the groin, external genital and abdominal
wall.

37. Great (long) saphenous veins
Along their length, the great saphenous veins
have from 10 – 20 valves, with more located in
the leg than the thigh.
These veins are more likely to be subject to
varicosities than other veins in the lower limbs
because they must support a long column of
blood are not well supported by skeletal muscles.
Often used for prolonged administration of
intravenous fluids – important in very young
children and in patient of any age who are in
shock and whose veins are collapsed.

38. Small saphenous veins
Begin at the lateral aspect of the dorsal venous
arches of the foot.
They pass posterior to the lateral malleolus of
the fibula and ascend deep to the skin along the
posterior aspect of the leg.
They empty into the popliteal fossa, posterior to
the knee.
Along their length, the small saphenous veins
have from 9 – 12 valves.
Drain the foot and posterior aspect of the leg.
They may communicate with the great
saphenous veins in the proximal thigh.

41. DEEP VEINS
Anterior
tibial veins
Posterior
tibial veins
Popliteal
veins
Femoral
veins

42. Posterior tibial veins
The plantar digital veins on the plantar surfaces
of the toes unite to form the plantar metatarsal
veins, which parallel the metatarsals.
Unite to form the deep plantar venous arches.
From each arch emerges the medial and lateral
plantar veins.
Posterior to the medial malleolus of the tibia, form
the paired posterior tibial veins, which sometimes
merge into a single vessel. They accompany the
posterior tibial artery through the leg.

43. Posterior tibial veins
They ascend deep to the muscles in the posterior
aspect of the leg and drain the foot and posterior
compartment muscles.
About two-third of the way up the leg, the
posterior tibial veins drain blood from the
fibular (peroneal) veins, which drain the lateral
and posterior leg muscles.
They unite with the anterior tibial veins just
inferior to the popliteal fossa to form the
popliteal veins.

47. Anterior tibial veins
The paired anterior tibial veins arise in the dorsal
venous arch and accompany the anterior tibial
artery.
Ascend in the interosseous membrane and unite
with the posterior tibial veins to form the popliteal
veins.
Drain the ankle joint, knee joint, tibiofibular joint
and anterior portion of the leg.

48. Popliteal veins
Formed by the union of the anterior and
posterior tibial veins.
Receive blood from the small saphenous veins
and tributaries that correspond to branches of
the popliteal artery.
Drain the knee joint and the skin, muscles and
bones of portion of the calf and thigh around the
knee joint.

49. Femoral veins
Accompany the femoral arteries and are
continuations of the popliteal veins just superior to
the knee.
The femoral veins extend up the posterior surface
of the thighs and drain the muscles of the thighs,
femurs, external genitals and superficial lymph
nodes.
The largest tributaries of the femoral veins are the
deep veins of the thigh (deep femoral veins).
Just before penetrating the abdominal wall, the
femoral veins receive the deep femoral veins and
the great saphenous veins.

50. Femoral veins
The veins formed from this union penetrate the
body wall and enter the pelvic cavity.
Here they are known as the external iliac veins.

60. Venous drainage
The chief superficial veins are the great and small
saphenous veins.
The great (or long) saphenous vein begins on the
medial side of the dorsal venous network of the foot.
It ascends about a finger breadth anterior to the
medial malleolus, where it can be found for
catheterization.

61. Venous drainage
It crosses the medial surface of the tibia
obliquely, passes posterior to the medial
condyles of the tibia and femur, and then
ascends along the medial side of the thigh.
In the femoral triangle, it pierces the cribriform
fascia (at the saphenous opening) and the
femoral sheath, ending in the femoral vein
A varicose vein is one that has permanently lost
its valvular efficiency, a condition that is not
uncommon in the great saphenous vein, which is
frequently tortuous and dilated when a subject is
in the erect position.

62. Venous drainage
The great saphenous vein receives many
tributaries, including the superficial epigastric
vein.
Communications occur between the superficial
epigastric vein and lateral thoracic veins (by way
of the thoraco-epigastric vein). Therefore, there is
a communication between the femoral and the
axillary veins.
These communications are important, and they
become enlarged in the event of obstruction of
either the superior or inferior vena cava.

63. Venous drainageThe small (or short) saphenous vein begins on the
lateral side of the dorsal venous network of the foot.
It passes posteror to the lateral malleolus and
ascends the posterior leg.
It then passes between the heads of the
gastrocnemius, pierces the fascia of the popliteal
fossa, and ends variably in the popliteal, great
saphenous, or some muscular veins.

64. Venous drainage
The chief deep veins of the lower limb are the
femoral and the popliteal veins.
The deep veins begin on the plantar aspect of the
foot and accompany the anterior and posterior tibial
arteries and the fibular artery.
Many valves are present.

65. Venous drainage
The superficial and deep veins are connected by
perforating veins.
 An important series is found in the leg, where
valves direct blood from superficial to deep
veins.
Muscular action, combined with the
arrangement of the valves, is important in
returning blood from the lower limb, and venous
return is much reduced during quiet standing,
when blood pooling may result in hypotension.

66. Lymphatic drainage
The superficial lymphatic vessels of the lower limb
are arranged as medial trunks, which end in the
inguinal nodes, and as a lateral set, which either
joins the medial trunks superior to the knee or ends
in the popliteal nodes.
 The popliteal nodes receive the deep lymphatic
trunks that accompany the tibial blood vessels and
the lateral group of superficial trunks.

67. Lymphatic drainage
Their efferents accompany the femoral blood
vessels to the deep inguinal nodes.
The inguinal nodes are mostly subcutaneous
and are frequently palpable in vivo.
The superficial inguinal nodes lie both
longitudinally along the great saphenous vein
and transversely, just inferior to the inguinal
ligament, whereas the deep inguinal nodes (into
which the superficial drain) lie medial to the
femoral vein.

68. Lymphatic drainage
When the inguinal nodes are found to be enlarged,
their territory of drainage, i.e., the trunk inferior to
the level of the umbilicus (including perineum,
external genitalia, and anus) as well as the entire
lower limb should be examined.
The efferent lymphatic vessels from the inguinal
nodes proceed to the external iliac nodes and drain
ultimately into the lumbar (aortic) nodes.