From what level does the popliteal artery begin? Popliteal artery, its topography and branches. Blood supply to the knee joint. Thrombosis and other complications

The popliteal artery is a fairly large vessel that directly continues downwards. It lies as part of the neurovascular bundle, together with the vein of the same name and the tibial nerve. At the back, on the side of the popliteal fossa, the vein lies closer to the surface than the artery; and the tibial nerve is even more superficial than the blood vessels.

Location and topography

Beginning at the lower aperture of the adductor canal, located under the semimembrane of mice, the popliteal artery is adjacent at the bottom of the popliteal fossa, first to the femur (directly to the popliteal surface), and then to the capsular membrane of the knee joint.

The lower part of the artery is in contact with It penetrates the narrow space between the bellies of the gastrocnemius muscle, which cover it. And having reached the edge of the soleus muscle, the vessel divides into the posterior and anterior tibial arteries.

Branches of the popliteal artery

Along its length, the popliteal artery gives off a number of branches:
. Upper muscular branches.
. Superior lateral genicular artery.
. Superior medial genicular artery.
. Middle genicular artery.
. Inferior lateral genicular artery.
. Inferior medial genicular artery.
. Calf arteries (two; less often - more).

Popliteal artery aneurysm

According to medical statistics, this is the most common location of aneurysms in the periphery: about 70% of peripheral aneurysms are localized in the popliteal region. The main cause of this pathological condition is considered to be atherosclerosis, since it is established as an etiological factor in the vast majority of patients with aneurysm of the popliteal artery.
Popliteal artery aneurysm develops almost regardless of age; The average age of patients is approximately 60 years, and the age range is from 40 to 90 years. Bilateral lesions are recorded in 50% of cases.
Much more often this disease affects men.
The clinical picture is dominated by symptoms of ischemic damage to the distal limb; Symptoms of compression of the nerve and vein (when they are compressed by an aneurysm) may also be added.
Complications:
. thrombosis of aneurysm (aneurysmal cavity);
. aneurysm rupture;
. calcification of the aneurysm;
. nerve compression.
For diagnostics the following are used:
. angiography;
. CT scan.
For treatment, ligation of the popliteal artery on both sides of the aneurysm (proximal and distal to it) is most often performed, followed by bypass surgery.

Thrombosis of the popliteal artery

A predisposing factor for the formation of blood clots in the arteries is damage to the inner surface of the vessels, the causes of which may be the following factors:
. atherosclerotic deposits on the walls of blood vessels;
. hypertonic disease;
. diabetes;
. trauma to the vascular wall;
. vasculitis

Clinical manifestations

Thrombosis of the popliteal artery is manifested by the following symptoms:
. Severe pain in the limb, appearing suddenly. Patients often compare its appearance to a blow. In the future, the pain may become paroxysmal; Moreover, an attack of pain leads to the appearance of sweat on the skin. Some reduction in pain over time does not mean an objective improvement in the patient’s condition.
. Pallor of the skin of the affected limb.
. Decreased skin temperature of the affected limb.
. The appearance of a thickening on the leg; its location coincides with the level of localization of the thrombus.
. Decreased and later disappearance of sensation in the leg; the appearance of paresthesia.
. Restricted mobility of the affected limb. In the future, mobility may be completely lost.
As a rule, symptoms develop gradually, starting with the onset of pain.
In the absence of adequate measures, a complication in the form of gangrene may develop. This condition is characterized by the presence of a clear boundary between normal and necrotic tissue. Subsequently, the necrotic area is mummified.
The worst case scenario is infection of the necrotic area. This condition is diagnosed by rapidly developing hyperthermia, pronounced leukocytosis in the blood and the presence of ulcerative decay.

Popliteal artery. a. poplilea, is a direct continuation of the femoral artery. Starting at the level of the lower opening of the canalis adductorius, it extends under the m. semimembranosus and runs along the bottom of the popliteal artery, adjacent first to the facies poplitea and then to the articular capsule of the knee joint, and in its lower section - to m. popli-tcus. The popliteal artery first has a downward and somewhat lateral direction, and then from the middle of the popliteal fossa takes an almost vertical direction. The lower section of the artery passes into the gap between the m heads covering it. gastrocnemius, and at the level of the lower edge of m. popliteus it follows between it and the heads of m. gastrococmius and under the edge of m. soleus is divided into the anterior tibial artery, a. tibialis anterior, and posterior tibial artery, a. tibialis posterior. The popliteal artery is accompanied throughout its 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 more superficially, and the vein is even more posterior or superficial to the artery and vein. Along its course, the popliteal artery gives off a number of branches that supply blood to the muscles and knee-joint. All these branches widely anastomose with each other, forming a dense vascular articular network of the knee, rete articulare genus.

The branches of the popliteal artery are as follows.

1. The upper muscular branches, numbering 35, supply blood to the distal areas of m. biceps, m. semimembranosus, m. semi-tcodinosus.
2. Lateral superior genicular artery, a. genus superior laleralis. departs from the popliteal artery, goes outward, lies under m. biceps femoris and, heading above the lateral condyle, breaks up into smaller branches that take part in the formation of the rete articulare genus.
3. Medial superior genicular artery a. genus superior medialis, directed anteriorly under the tendons of m. semimembranosus and m. adductor magnus above the medial condyle and, bending around the inner side of the femur, takes part in the formation of the articular network of the knee.
4. Middle genicular artery, a. genus media, directed from the popliteal artery anteriorly, pierces above the lig. popliteum obliquum capsule of the knee joint and gives off a number of branches to the synovial membrane of the joint and cruciate ligaments.
5. Lateral inferior genicular artery, a. genus inferior laleralis, starts from the most distal part of the popliteal artery, passes under the lateral head of the m. gastrocnemius and m. biceps femoris, bends around
knee-joint above the head of the fibula and, emerging on the anterior surface of the knee, takes part in the formation of the rete articulare genus.
6. Medial inferior genicular artery, a. genus inferior medialis, lies under the medial head of m. gastrocnemius and goes around the medial periphery of the knee joint, lying under the lig. collateral tibiale. The branches of the artery are part of the network of the knee joint.
7. The gastrocnemius arteries, aa.. swales, number 2 (sometimes more), arise from the posterior surface of the popliteal artery and, breaking up into a number of smaller branches, supply blood to the proximal parts of the triceps (gastrocnemius and plantar)
calf muscles and skin of the lower leg.

Everything in the human body is unique and interconnected. It grows and ages, fights infections, regenerates and creates its own kind. Each of its systems and specific organs perform their own work. The musculoskeletal system ensures human statics (certain body positions) and makes various movements possible. Thanks to bones, joints, and muscles, the human body has a “figure” and can run, jump, and swim.

The knee joint is one of the largest joints. Being part of the belt of the lower extremities, it provides both statics and dynamics of a person. Without its normal functionality, motor activity is sharply reduced, working capacity is reduced, and a person is forced to adjust his life, work and rest.

The anatomy of the human knee joint is very interesting and educational from the point of view of the rationality and brevity of its structure. There is nothing superfluous, each component is optimal, functional and fulfills its purpose. By analogy with other joints, the knee includes bones, cartilage, and an articular capsule. It is strengthened and protected by ligaments and tendons, has an extensive network of blood vessels and nerves, and is driven by powerful muscles.

Bones, ligaments and cartilage

The joint is of the condylar type, characterized by the presence of condyles on a convex bone and a flatter surface on the other. The structure of the knee joint allows mainly flexion and extension movements in it. The extension amplitude, that is, the deviation from the original position (straight axis of the thigh and lower leg), is normally no more than 5 degrees. If it is more, then this is a pathological extension, leading to knee deformation.

Flexion (active or passive) can go up to 160 degrees when the heel touches the buttocks. The greatest angle of flexion is observed in athletes or physically active individuals. Movements in other planes (abduction and adduction, inward and outward rotation) are carried out from a flexion position, the angle is not more than 20.

The anatomy of the human knee joint includes the femur, tibia, and patella. The fibula is located outside the joint, attached to the tibia by a small, immovable joint. The end of the femur has a convex surface and two round bony protrusions, the lateral and medial condyles. On the anterior surface there is a patellofemoral groove, along which the patella moves.

The condyles, the back of the patella and the flat surface of the tibia have a smooth and elastic coating. This is hyaline cartilage, without which the joint is impossible to function, with a thickness of up to 6 mm. The combination of elasticity and strength, resistance to compression, and the ability to recover with the help of chondrocytes are very important for long and uninterrupted functioning. Collagen in articular cartilage ensures free movement of bones in the joint capsule, reduces friction and dampens shock waves.

The ligaments of the knee joint provide connection between the bone elements and prevent their unnecessary dangerous movements. Two collateral ligaments hold the joint in the lateral plane. The anterior and posterior cruciate ligaments protect against dislocations in the anteroposterior direction.

The menisci of the joint are made of connective tissue, like ligaments, but they are denser and stronger. They are located between the condyles and the tibial plateau and save the articular cartilage from deformation and excessive stress. Injury to the menisci and their improper treatment lead to cartilage degeneration and failure of the entire joint.

The knee joint is surrounded by three joint capsules (bursae): on the back surface, on the inner surface and around the patella. The synovial fluid that fills them plays the role of a shock absorber during movements. It is also important as a lubricant between the cartilage-covered surfaces of bones. With injury or inflammation of the synovial bursae, bursitis of the knee joint develops.

Muscles, blood vessels and nerves

To provide basic movements in the knee joint, flexion and extension, there are flexor and extensor muscles. The quadriceps femoris, a very powerful muscle, is an extensor muscle. It starts from the ilium and, covering the anterior and lateral surfaces of the thigh, is attached to the patella, ending with a tendon on the tibial tuberosity.

This muscle extends the leg from any starting position, and also tilts the torso forward with a fixed limb. The patella serves to evenly redistribute the force of the quadriceps muscle.

Several muscles are used to bend the leg at the knee: biceps, sartorius, popliteal, semimembranosus, and gracilis. Pronation is provided by six muscles, and supination by two. These movements are only possible during knee flexion, when the collateral ligaments are in a free state. All muscle groups surrounding the knee joint act harmoniously and dynamically, making movements free and smooth.

The blood vessels supplying the joint are branches of large arteries: femoral, popliteal, deep femoral artery, anterior tibial. The resulting network of small vessels and capillaries envelops the entire joint, penetrating bones, ligaments, and muscles. Without good vascular permeability, normal joint function is impossible. Venous blood flows through superficial and deep veins running parallel to the arteries. Their network is most developed on the inner surface of the knee.

The innervation of the knee joint, or the presence of nerve fibers in it, is provided by three nerve trunks. These are the tibial, peroneal and sciatic nerves. Receptors are present in all elements of the joint. They immediately react in case of injury, inflammation, allergic process, or changes in trophism. Innervation is necessary for the synchronous operation of all mechanisms that ensure the functionality of the joint.

The health and performance of the knee joint depend on the condition of all its elements. It is necessary to protect them from injury, excessive stress and inflammation.

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

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

Popliteal artery aneurysm must be operated on as soon as possible after diagnosis. There is no need to hope that it will “resolve” on its own. The high risk of acute ischemia and good results of planned operations should encourage the patient to consent to surgery. The results of planned interventions are very good.

Treatment technologies at the Innovative Vascular Center

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

Causes

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 artery wall, which contributes to their pathological expansion. The majority of patients (95%) are elderly men with a mean age of approximately 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 to the popliteal region, dislocations or fractures. Patients with multiple aneurysms in different arteries should have general tissue weakness. The exact nature of this is still not clear. 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 in nature and the patient may not realize that he has such a dangerous disease.

With thrombosis of an aneurysm, a clinical picture of acute ischemia develops - severe pain in the affected limb, changes in color and skin temperature of the foot. Subsequently, disturbances in sensitivity and movement develop. With advanced acute ischemia, rigor of the 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 wall of the vessel, it does not pose any danger. If a clot fragment 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 rupture (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 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 an aneurysm, the probability of thrombosis and acute ischemia with limb loss is 20% per year. Ignorance of one’s pathology and false hopes for chance lead to the development of severe complications.

Planned operations are successful in 100% of patients and their effectiveness remains for many years.

After surgical treatment of a popliteal aneurysm, recovery usually occurs. During 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, the only option is amputation.

Popliteal artery(a. poplitea), being a continuation of the femoral, is located in the popliteal fossa along with the vein of the same name and the sciatic or tibial nerves. The popliteal fossa is bounded at the top on the lateral side by the biceps muscle, on the medial side by the semimembranosus, and below by the two heads (medial and lateral) of the gastrocnemius muscle. The bottom of the fossa is formed by the popliteal surface of the femur, the capsule of the knee joint and the popliteal muscle.

Under the own fascia in the fossa, occupying a median position, in the direction from top to bottom lie the above-mentioned nerve, vein, artery - a memorable word for the syntopy of the neurovascular bundle

« Neva" - according to the first letters of the components of the neurovascular bundle. The popliteal artery is located close to the bone, capsule and muscle (take into account the possibility of damage due to injury!). Its average length

– 16 cm, diameter – 13 mm. At the level of the lower edge of the popliteus muscle, the artery divides into terminal branches- tibial anterior and posterior.

Lateral branches of the popliteal artery

· Lateral superior genicular artery(a. genus superior lateralis) - begins above the lateral femoral condyle, supplies blood to the vastus lateralis and biceps muscles, and the knee joint.

· Medial superior genicular artery(a. genus superior mtdialis) - begins at the level of the medial femoral epicondyle - for the vastus medialis muscle and the capsule of the knee joint.

· Middle genicular artery(a. genus media) – to the posterior wall of the joint capsule, its menisci, cruciate ligaments, synovial folds.

· Medial inferior genicular artery(a. genus inferior medialis) departs at the level of the medial condyle of the tibia - for the medial head of the gastrocnemius muscle, capsule of the knee joint.

· Lateral inferior genicular artery(a. genus inferior lateralis) – for the lateral head of the gastrocnemius and long plantar muscles.

All branches, connecting with each other, form around the knee joint arterial network. In addition, they participate in the blood supply to the knee joint and the formation of its network descending genicular branch of the femoral artery(a. genus descendens), recurrent branches of the posterior and anterior tibial arteries (r. recurrens tibialis posterior, r. recurrens tibialis anterior). With maximum bending of the knees, compression of the popliteal arteries occurs, but the blood flow is not disturbed due to the presence of a well-developed arterial network of the knee joints.

21(IV) Arteries of the leg

To the arteries of the leg belong to the tibia: anterior and posterior (a. tibialis anterior et a. tibialis posterior). They are the final branches of the popliteal artery and begin from it at the level of the lower edge of the popliteal muscle. Together with the veins of the same name, the tibial and peroneal nerves, they form three neurovascular bundles of the lower leg. Posterior bun It includes the posterior tibial artery, 2-3 accompanying deep veins and the tibial nerve. Front the bundle consists of the anterior tibial artery, 2-3 accompanying deep veins and the deep branch of the peroneal nerve, side bundle - from the peroneal artery, 2-3 accompanying deep veins and the superficial branch of the peroneal nerve.

The posterior bundle passes in the superior tibial-popliteal canal between the tibialis posterior and flexor pollicis longus anteriorly and the soleus posteriorly. Upon exiting it at the border of the middle and lower third of the leg, the bundle lies relatively superficially, under the medial edge of the soleus muscle and the fascia proper of the leg. At the level of the medial malleolus, the posterior neurovascular bundle enters under the flexor retinaculum (medial malleolar fibrous canal) and exits through the calcaneal canal to the sole.

The posterior tibial artery (a. tibialis posterior) is a direct continuation of the popliteal and at the level of the upper third of the leg gives off the largest branch- peroneal artery(a. fibularis seu a. peronea), which, together with 2 deep veins of the same name, passes under the long flexor pollicis and enters the lower musculofibular canal (between the fibula and the above-mentioned muscle). Behind the lateral malleolus it divides into terminal branches: lateral malleolar and calcaneal(rr. malleolares laterales, rr. calcanei) - for the collateral network of the ankles and heel.

The peroneal artery supplies the peroneus longus and brevis muscles and the lateral border of the triceps muscle. Below, its perforating branch connects with the lateral anterior malleolar artery from the anterior tibial. Its connecting branch anastomoses with the posterior tibial artery in the lower third of the leg.

Small branches posterior tibial artery:

· The branch that goes around the head of the fibula is involved in the formation of the network of the knee joint and the blood supply to the peroneal muscles.

· Muscular branches are directed to the posterior muscles of the leg: triceps, tibialis posterior, flexor pollicis longus, flexor digitorum longus.

Terminal branches posterior tibial artery - medial and lateral plantar arteries(a. plantaris medialis et a. plantaris lateralis) supply blood to the foot. The medial plantar artery divides into deep and superficial branches. The larger and longer lateral plantar artery forms a plantar arch at the level of the bases of the metatarsal bones, which at the first metatarsal bone anastomoses with the deep branch of the dorsal artery of the foot. From the plantar arch begin 4 metatarsal arteries with piercing branches and common digital arteries.

Anterior tibial artery(a. tibialis anterior) starts from the popliteal at the lower edge of the popliteal muscle, passes slightly in the tibial-popliteal canal, at the level of the upper third leaves it through the upper anterior opening of the interosseous membrane and descends downwards along it, gradually approaching the skin, passes to the foot as dorsal artery.

· recurrent: anterior and posterior (a. recurrens tibialis anterior, a. recurrens tibialis posterior) - for the knee arterial network and blood supply to the knee and tibiofibular joints, tibialis anterior muscle and extensor digitorum longus;

· ankle anterior: medial and lateral (a. malleolaris anterior medialis, a. malleolaris anterior lateralis) - for the formation of ankle networks, supplying the ankle joint, tarsal bones and its joints;

· final branch - dorsal artery of the foot (a. dorsalis pedis) with the first metatarsal, deep plantar, tarsal (lateral and medial), arcuate branches and I – IV digital branches.

Blood supply ankle joint carried out by the ankle branches of the tibial and peroneal arteries, which form the medial and lateral ankle and calcaneal networks, continuing anteriorly and posteriorly to the joint capsule. Medial ankle network (rete malleolare mediale) occurs when the medial anterior malleolar artery from the anterior tibial artery joins the medial malleolar branch from the posterior tibial artery and the medial tarsal branches of the dorsalis pedis artery. IN lateral malleolar network(rete malleolare laterale) the lateral anterior malleolar artery is anastomosed from the anterior tibial artery, the lateral malleolar and perforating branches from the peroneal artery. Heel net (rete calcaneum) formed by the fusion of the calcaneal branches of the posterior tibial and peroneal arteries.

22(IV) Arteries of the foot