Introduction
The lateral circumflex femoral artery (LCFA) is an important artery of the lower limb. The LCFA is a laterally running branch given off near the root of Profunda Femoris (PFA) which is the largest branch of Femoral artery (FA). The artery takes part in trochanteric anastomosis, cruciate anastomosis and the anastomosis around the knee joint respectively. It passes between branches of femoral nerve, posterior to sartorius and rectus femoris and divides into ascending, transverse and descending branches.1 The study in branching pattern of these main vessels of lower limb can help the operating surgeons reduce the chances of intra operative injury to involving these vessels.2
Materials and Methods
The present study was conducted in 46 dissected specimens of lower limb of unknown age and sex for a period of 6 months. The branching pattern of the FA, PF and LCFA was observed in detail and noted.
Results
In present study the LCFA originated from PF in 46 specimens (92%) (Figure 1) and from FA in 4 cases (8%) (Figure 2). When LCFA branched from the deep FA, the mean distance was 1.5 cm from the origin of deep FA (Siddharth). In the present study, the mean distance of origin of LCFA was 2.3 cm (range 0.3-7 cm) (Table 1).
Discussion
Lateral Circumflex Femoral Artery may arise from FA,2 Sometimes the LCFA fairly rises from FA above the PFA.3 According to a study among 200 limbs LCFA originated from PFA in 123 limbs and in 26 limbs LCFA from FA.4
A case of bilateral variation in the origin of LCFA, on the right side it arose from FA, proximal to the origin of PF. In addition, another lateral branch was seen arising from PF making it double LCFA on the right side. On the left side, LCFA was seen arising from FA at the level of PF.5 LCFA in 52 (81.25%) extremities originated from PF; whereas in 12 (18.75%) extremities it originated from FA.6
The origins of LCFA in 110 inguinal regions of 56 cadavers between 1997 and 2007. The LCFA was found to be branched from the deep FA in 85 (77.3%) cases and from FA in 21 (19.1%) cases. In two (1.8%) cases the ascending and the descending branches of LCFA branched separately from deep FA and FA. There was a common trunk of deep FA and LCFA in one (0.9%) case, and a common trunk of deep FA, LCFA and MCFA (trifurcation) in another (0.9%). They also measured the distance between MIP and origin of LCFA. For LCFAs branching from deep FA the mean distance between these points was 4.8 +/- 1.2 cm, while for LCFAs branching from FA the mean distance was 3.4 +/- 0.9 cm.7
The small branches of FA in the femoral triangle were not palpable and could increase the risk of intravascular injection during femoral nerve block. The author evaluated the position of LCFA system and the perforators nourishing the anterolateral thigh flap. They found regularly most musculocutaneous perforators mainly in the central third of thigh arising from the descending branch of LCFA.8 Variant origin of LCFA is important during harvesting of anterolateral thigh flaps, aorto-popliteal by-pass, coronary artery grafting, and vascularised iliac transplant. They studied the artery in 84 lower limbs and they observed that it was a branch of PF in only 65.5% of cases. Variant origins included from a common trunk with MCFA (14.3%), with PF (10.7%), as a trifurcation with PF and MCFA (7.1%), and from FA (2.4%). Variant origin of LCFA occurred in nearly 35% of the Kenyan population studied, much lower than in oriental populations. The most frequent variant origin is as a common trunk with MCFA and PF, with a very low prevalence of origin from FA.9
Conclusion
The anatomical knowledge of LCFA helps in catheterization, reconstructive procedures and surgical intervention of the thigh and hip region. Anatomical variation of distance of origin and from main arterial trunk may lead to severe haemorrhage and may misguide during surgical intervention. Anatomical knowledge of LCFA is used as a long vascular pedicle in anterolateral perforator thigh flap and in breast reconstruction after mastectomy.
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