It is known that a different ramification pattern can occur as a function of the development of the arteries of the lower limb. During a routine dissection, a variation of the deep femoral artery was found passing in front of the femoral vein in the left lower limb of a 43-year-old male cadaver. This case is reported because of its rare occurrence in the literature. The variation is discussed on the basis of the possible embryological development of the lower limb arteries

Bilgic, Sait

Emirzeoglu, Mehmet

Kosif, Rengin

Sahin, Bünyamin

Uzun, Ahmet

English

Via Medica Journals

Folia Morphol. Vol. 62, No. 2, pp. 143–146Copyright © 2003 Via MedicaISSN 0015–5659www.fm.viamedica.plC A S E  R E P O R T143Address for correspondence: Assistant Prof. Dr Bünyamin Sahin, P.K. 124, Samsun, Turkey, tel: ++90 362 457 6000 ext.: 2262,fax: ++90 362 457 6041, e-mail: bsahin@omu.edu.trA deep femoral artery passing in front ofthe femoral veinBünyamin Sahin, Ahmet Uzun, Mehmet Emirzeoglu, Rengin Kosif, Sait BilgicDepartment of Anatomy, School of Medicine, Ondokuz Mayis University, Samsun, Turkey[Received 4 February 2003; Revised 20 March 2003; Accepted 20 March 2003]It is known that a different ramification pattern can occur as a function of thedevelopment of the arteries of the lower limb. During a routine dissection,a variation of the deep femoral artery was found passing in front of the femoralvein in the left lower limb of a 43-year-old male cadaver. This case is reportedbecause of its rare occurrence in the literature. The variation is discussed on thebasis of the possible embryological development of the lower limb arteries.key words: deep femoral artery, anatomical variation, lower limbINTRODUCTIONThe course and the ramification of the vessels ofthe lower limbs have long received attention fromanatomists and surgeons. It has been reported thatarteriovenous fistulas can occur in the groin regionas a complication of the percutaneous angioplastyor cardiac catheterisation of the femoral vessels [2,7]. Thus, a complete understanding of the anatomyof the femoral triangle is necessary in order to avoidthis and other complications [3, 11]. In addition, theexistence of embryological variations of the arteriesof the lower limb often results from unexpected de-velopmental defects of the embryological arterialnetwork.During embryological development, the channelsof the primary capillary plexuses and primitive sciat-ic artery regress and the appropriate vascular chan-nels enlarge. Thus the sciatic artery disappears andthe main blood flow begins to come from the femo-ral artery. Consequently, the final arterial patternestablishes in the front of the thigh [8, 11, 12, 16,17]. Several case reports on the ramification patternand variations of both femoral and deep femoralarteries have been reported [1, 6, 17, 19–23]. How-ever, a variation where the deep femoral artery ac-tually passes in front of the femoral vein is rare inthe literature [4, 5, 9, 13, 14].CASE REPORTA variation of the deep femoral artery was foundin the left lower limb of a 43-year-old adult malecadaver during dissection of the lower limbs of 18adult cadavers at the Department of Anatomy inOndokuz Mayis University, School of Medicine. Thedeep femoral artery arose from the medial surfaceof the femoral artery, 3.7 cm distal to the inguinalligament. The artery then ran inferomedially andcrossed the anterior surface of the femoral vein justbelow the insertion point of the great saphenousvein to the femoral vein, as shown in Figure 1.The deep femoral artery reached the medial bor-der of the femoral vein, descended on the medialsurface of the vein and turned laterally to eventuallycross posterior to the vein before entering the deeppart of the thigh. On reaching the medial border ofthe femoral vein, the deep femoral artery gave offthe medial circumflex femoral artery. The lateral cir-cumflex femoral artery originated from the posteri-144Folia Morphol., 2003, Vol. 62, No. 2or surface of the femoral artery, 4.9 cm below theinguinal ligament and distal to the origin of the deepfemoral artery.DISCUSSIONThe existence of variations of the vessels of thelower limb can most often be explained as an abnor-mal development of the arterial network of the lowerlimb in the embryo [8, 16]. The primary sciatic arterytraverses the sciatic nerve and forms the main bloodsupply of the lower limb when the embryo is 10 mmlong [11, 18]. The sciatic artery then persists in mostvertebrates; however, the femoral artery, as the con-tinuation of the external iliac artery, becomes the mainartery of the lower limb in mammals, with regressionof the sciatic artery. This process may be the mainreason for the differences of the ramification of thearteries between other vertebrates and humans [9].Very early in the developmental process, anasto-moses can be found between the dorsal sciatic ar-tery and ventral femoral artery [8, 12]. Later, capil-laries in front of the pelvis and thigh form complexvascular networks, named the rete pelvicum and retefemorale. It is generally accepted that an increase ofblood-flow in these capillaries determines the finalmature arterial pattern. Thus, the most appropriatechannels enlarge while others contract and disap-pear, thereby establishing the final arterial ramifica-tion [16, 18]. Concurrently, the sciatic artery regressesas the main blood flow and the popliteal artery be-gins to come from the femoral artery. Other parts ofthis anastomotic network are the precursors to thefinal deep femoral artery [8]. The initial part of thesciatic artery remains as the inferior gluteal arteryand ramus concomitans to the sciatic nerve to sup-ply the gluteal region and the sciatic nerve (Fig. 2).Formation of the arteries of the lower limbs iscompeted during the third month of gestation witha pattern that corresponds to the adult [10].Although we can only speculate, one possiblereason for the observed variation of the deep femo-ral artery in this case could be increased blood flowin the rete femorale vessels located in front of thefemoral vein, thus forming a variation of the deepfemoral artery. Additionally, the femoral vein’s en-trance into the rete femorale could effect the arterialplexus and produce the unusual selection of thecapillaries to form a final deep femoral artery pass-ing in front of the femoral vein. In most other verte-brates, the inferior epigastric, superior epigastric andFigure 1A, B. The deep femoral artery passing in front of the femoral vein A and its diagram B in the left lower limb of a male adultcadaver; 1 — femoral artery, 2 — deep femoral artery, 3 — medial circumflex femoral artery, 4 — lateral circumflex femoral artery,5 — femoral vein, 6 — great saphenous vein.145Bünyamin Sahin et al., Variation of  deep femoral arterydeep femoral arteries arise by a common trunk thatlies anterior to the femoral vein; however, the con-dition is rather different for primates [9].In our case, only one out of 18 cadavers exhibit-ed a deep femoral artery passing in front of the fem-oral vein, and this was found only in the left lowerlimb. In two of the previously reported cases, theanomalous deep femoral arteries were also found inthe left lower limb of the cadavers [9, 14]. However,the reports and the ratios on the existence of re-ported variation are not enough to obtain a satisfy-ing prediction on the incidence or side preference ofthe variation in population.The importance of knowing the normal anatomyand the anomalies of the femoral artery, femoral veinand the other vessels in the region has been empha-sised by many clinicians [2, 7]. Before the catheteri-sation of femoral vessels and operations in the fem-oral triangle, high-resolution ultrasonic imaging canprovide anatomic and functional information aboutthe femoral vessels and would be of assistance inplanning catheterisation [15]. A crossing deep fem-oral artery in front of the femoral vein may also causeobstruction to the femoral vein [14], or it may pro-duce an arteriovenous fistula during femoral veincatheterisation. This reported variation must also beregarded as a possibility during the surgical repairof femoral hernias [9].ACKNOWLEDGEMENTSWe would like to thank Prof. Dr Leonard L. Seelig,Department of Cellular Biology and Anatomy, HealthScience Center, Louisiana State University, USA forlanguage revision of the manuscript.REFERENCES1. Adachi B (1928) Das arteriensystem der Japoner.Maruzen, Kyoto.2. Altin RS, Flicker S, Naidech HJ (1989) Pseudoaneurysmand arteriovenous fistula after femoral artery cathe-terization: Association with low femoral punctures.AJR, 152: 629–631.3. Baum PA, Matsumoto AH, Teitelbaum GP Zuurbier RA,Barth KH (1989) Anatomic relationship between thecommon femoral artery and vein: CT evaluation andclinical significance. Radiology, 173: 775–777.4. Bergman RA, Afifi AK, Miyauchi R (2001) Illustrated en-cyclopedia of human anatomic variation: part II: Cardio-vascular System: Arteries: Lower Limb; Femoral Artery.5. Bergman RA, Thompson SA, Afifi AK, Saadeh FA (1988)Compendium of Human Anatomic Variation, Urban& Schwarzenberg, Baltimore.6. Bilgic S, Sahin B (1997) Rare arterial variation: a com-mon trunk from the external iliac artery for the obtu-rator, inferior epigastric and profunda femoris arte-ries. Surg Radiol Anat, 19: 45–47.7. Davis C, VanRiper S, Longstreet J, Moscucci M (1997)Vascular complications of coronary interventions. HeartLung, 26: 118–127.8. Greebe J (1977) Congenital anomalies of the iliofemo-ral artery. J Cardiovas Surg, 18: 317–323.9. Johnston TB (1912) A rare anomaly of the arteria pro-funda femoris. Anat Anz, 42: 269–272.10. Keen JA (1961) A study of the arterial variations in thelimbs, with special references to symmetry of vascularpatterns. Am J Anat, 108: 245–261.11. Lamar R, Berg R, Rama K (1990) Femoral arteriovenousfistula as a complication of percutaneous translumi-nal coronary angioplasty. A report of five cases. AmSurgeon, 56: 702–706.12. Lippert H, Pabst R (1985) Arterial variations in man. JFBergmann Verlag, München.13. Lipshutz BB (1916) Study on the blood vascular tree I.A composite study of the femoral artery. Anat Rec,10: 361–370.Figure 2. Diagram of the development of the arteries of the lower limb [modified from Sanudo et al. (1993)]; il — inguinal ligament,1 — rete femorale, 2 — rete pelvicum, 3 — sciatic artery, 4 — femoral artery, 5 — deep femoral artery, 6 — medial circumflex femoralartery, 7 — lateral circumflex femoral artery, 8 — femoral vein.146Folia Morphol., 2003, Vol. 62, No. 214. Sahin B, Bilgic S (1998) Two rare arterial variations ofthe deep femoral artery in the newborn. Surg RadiolAnat, 20: 233–235.15. Sahn DJ, Goldenberg SJ, Allen HD, Valdes-Cruz LM,Canale JM, Lange L, Friedman MJ (1982) A new tech-nique for noninvasive evaluation of femoral arterialand venous anatomy before and after percutaneouscardiac catheterization in children and infants. Am JCardiol, 49: 349–355.16. Sanudo JR, Roig M, Rodrigues A, Ferreira B, DomenecJM (1993) Rare origin of the obturator, inferior epigas-tric and medial circumflex femoral arteries from a com-mon trunk. J Anat, 183: 161–163.17. Schmidt J, Paets B, Allenberg JR  (1990) Bilateral con-genital aplasia of the deep femoral arteries. Ann VascSurg, 4: 98–501.18. Senior HD (1919) The development of the arteries ofthe human lower extremity. Am J Anat, 23: 55–95.19. Siddharth P, Smith NL, Mason RA, Giron F (1985) Varia-tional anatomy of the deep femoral artery. Anat Rec,212: 206–209.20. Suder E, Nizankowski C (1985) Variations in the originof the deep femoral arteries in human fetuses. FoliaMorphol (Warsz), 154: 262–269.21. Vobaril R (1990) Note on variability of the arteries ofthe lower extremities in man. Folia Morphol (Warsz),38: 265–273.22. Williams GD, Martin CH, McIntire LR (1934) Origin ofthe deep and circumflex group of arteries. Anat Rec,60: 189–196.23. Williams PL (1995) Gray’s Anatomy. 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A deep femoral artery passing in front of the femoral vein

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A deep femoral artery passing in front of the femoral vein

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