Anat Cell Biol.  2024 Sep;57(3):346-352. 10.5115/acb.24.047.

Reappraisal of anatomical diversity of lateral circumflex femoral artery with its substantial clinical applicability: cadaveric study

• Chaudhary A
• Patra A
• Garg P

• KMID: 2559747
• DOI: http://doi.org/10.5115/acb.24.047

Abstract

Studies reveal variations in the in the origin, number, and branching patterns of the lateral circumflex femoral artery (LCFA). The present study aimed to document such variations and their potential clinical applicability. Thirty-two femoral triangles of 16 embalmed adult human cadavers were dissected to investigate the variation in the origin, number, and branching patterns of LCFA. The main branches of the LCFA were tracked independently for numerical variations in branching pattern. The distance between the origin of LCFA and mid inguinal point (MIP) was also measured in each case. LCFA was most commonly arising from profunda femoris (PF), followed by femoral artery (FA) and common trunk of the femoral artery (CFA). Duplication LCFA was observed in 15 (46.87%) limbs, in 5 (31.25%) cases duplication was only on right side, in 4 (25%) cases duplication was only on left side and in 3 (18.75%), duplication was bilateral. Cases with duplication of LCFA, showed numerical variations with descending pattern being the most common. The average distance of LCFA1 and LCFA2 from mid-inguinal point was 5.77±1.35 cm and 6.14±2.05 cm respectively. Detailed information regarding the occurrence of duplication will be great importance for surgeons, interventional radiologists, and other medical professionals performing procedures in the femoral region. Knowledge of variation of branching pattern of LCFA is utmost important as surgeons use the descending branch of the LCFA in bypass grafting and vascular reconstruction surgeries.

Keyword

Structural variations; Surgical flap; Vascular surgical procedure; Vascular grafting

Figure

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  Fig. 1 Showing duplication of lateral circumflex femoral artery (LCFA) arising from profunda femoris (PF) artery as a common trunk. FA, femoral artery; FN, femoral nerve; LCF1, upper LCFA; LCF2, lower LCFA; R, right; S, superior; L, left; I, inferior.

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  Fig. 2 Duplication of lateral circumflex femoral artery (LCFA) arising from profunda femoris (PF) artery at different level. FA, femoral artery; FN, femoral nerve; LCF1, upper LCFA; LCF2, lower LCFA; R, right; S, superior; L, left; I, inferior.

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  Fig. 3 LCF1 and profunda femoris (PF) artery arises as a common trunk and LCF2 arises from PF. LCFA, lateral circumflex femoral artery; FA, femoral artery; FN, femoral nerve; LCF1, upper LCFA; LCF2, lower LCFA; R, right; S, superior; L, left; I, inferior.

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  Fig. 4 Showing origin of LCF1 from profunda femoris (PF) artery and LCF2 arise from FA. LCFA, lateral circumflex femoral artery; FA, femoral artery; FN, femoral nerve; LCF1, upper LCFA; LCF2, lower LCFA; R, right; S, superior; L, left; I, inferior.

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  Fig. 5 Showing origin of two LCFA as a common trunk from FA. LCFA, lateral circumflex femoral artery; FA, femoral artery; PF, profunda femoris; FN, femoral nerve; LCF1, upper LCFA; LCF2, lower LCFA; R, right; S, superior; L, left; I, inferior.

Reference

References

1. Valdatta L, Tuinder S, Buoro M, Thione A, Faga A, Putz R. 2002; Lateral circumflex femoral arterial system and perforators of the anterolateral thigh flap: an anatomic study. Ann Plast Surg. 49:145–50. DOI: 10.1097/00000637-200208000-00006. PMID: 12187341.

2. McMinn RMH. Last's anatomy. 9th ed. Churchill Livingstone;1994. p. 155–6.

3. Standring S. Standring S, editor. Pelvic girdle, gluteal region and hip joint, profunda femoris artery. Gray's Anatomy, the Anatomical Basis of Clinical Practice. 40th ed. Elsevier Churchill Livingstone;2008. p. 1379–80.

4. Mamatha H, D’souza AS, Jessica S, Suhani S. 2012; A cadaveric study on the variations in the origin, course and branching pattern of the profunda femoris artery. Int J Cur Res Rev. 4:137–45.

5. Lin CH, Wei FC, Lin YT, Yeh JT, Rodriguez Ede J, Chen CT. 2006; Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg. J Trauma. 60:1032–6. DOI: 10.1097/01.ta.0000218248.22811.70. PMID: 16688066.

6. Sinkeet SR, Ogeng'o JA, Elbusaidy H, Olabu BO, Irungu MW. 2012; Variant origin of the lateral circumflex femoral artery in a black Kenyan population. Folia Morphol (Warsz). 71:15–8. PMID: 22532179.

7. Uzel M, Tanyeli E, Yildirim M. 2008; An anatomical study of the origins of the lateral circumflex femoral artery in the Turkish population. Folia Morphol (Warsz). 67:226–30. PMID: 19085859.

8. Łabętowicz P, Olewnik Ł, Podgórski M, Majos M, Stefańczyk L, Topol M, Polguj M. 2019; A morphological study of the medial and lateral femoral circumflex arteries: a proposed new classification. Folia Morphol (Warsz). 78:738–45. DOI: 10.5603/FM.a2019.0033. PMID: 30906974.

9. Strickland BA, Bakhsheshian J, Rennert RC, Fredrickson VL, Lam J, Amar A, Mack W, Carey J, Russin JJ. 2018; Descending branch of the lateral circumflex femoral artery graft for posterior inferior cerebellar artery revascularization. Oper Neurosurg (Hagerstown). 15:285–91. DOI: 10.1093/ons/opx241. PMID: 30125010.

10. Romanes GJ. Cunningham's manual of practical anatomy upper and lower limbs (vol 1). 15th ed. Oxford University Press;1986.

11. Dimri P, Deshwal AK. 2014; Bilateral high origin of Profunda femoris artery- a case report and embryological review. Int J Sci Res. 3:375–6. DOI: 10.15373/22778179/JAN2014/128.

12. Devi AM, Kumar S, Bandopadhyay D. 2019; Study of anatomical variations of profunda femoris artery in the Indian population. Indian J Anat. 8:5–8. DOI: 10.21088/ija.2320.0022.8119.1.

13. Tomaszewski KA, Vikse J, Henry BM, Roy J, Pękala PA, Svensen M, Guay D, Saganiak K, Walocha JA. 2017; The variable origin of the lateral circumflex femoral artery: a meta-analysis and proposal for a new classification system. Folia Morphol (Warsz). 76:157–67. DOI: 10.5603/FM.a2016.0056. PMID: 27714726.

14. Manjappa T, Prasanna LC. 2014; Anatomical variations of the profunda femoris artery and its branches-a cadaveric study in South Indian population. Indian J Surg. 76:288–92. DOI: 10.1007/s12262-012-0677-3. PMID: 25278652. PMCID: PMC4175671.

15. Dixit D, Kubavat DM, Rathod SP, Patel MM, Singel TC. 2011; A study of variations in the origin of profunda femoris artery and its circumflex branches. Int J Biol Med Res. 2:1084–9.

16. Prakash , Kumari J, Kumar Bhardwaj A, Jose BA, Kumar Yadav S, Singh G. 2010; Variations in the origins of the profunda femoris, medial and lateral femoral circumflex arteries: a cadaver study in the Indian population. Rom J Morphol Embryol. 51:167–70. PMID: 20191139.

17. Keen JA. 1961; A study of the arterial variations in the limbs, with special reference to symmetry of vascular patterns. Am J Anat. 108:245–61. DOI: 10.1002/aja.1001080303. PMID: 14454801.

18. Gradman WS. 1992; Bypass to the lateral circumflex femoral artery. Ann Vasc Surg. 6:344–6. DOI: 10.1007/BF02008791. PMID: 1390022.

19. Siddharth P, Smith NL, Mason RA, Giron F. 1985; Variational anatomy of the deep femoral artery. Anat Rec. 212:206–9. DOI: 10.1002/ar.1092120216. PMID: 3842043.

20. Fukuda H, Ashida M, Ishii R, Abe S, Ibukuro K. 2005; Anatomical variants of the lateral femoral circumflex artery: an angiographic study. Surg Radiol Anat. 27:260–4. DOI: 10.1007/s00276-004-0312-5. PMID: 15682274.

21. Sahana SN. Sahana SN, editor. Circulatory system, profunda femoris artery. Human Anatomy. 3rd ed. The Central Book Agency;1982. p. 245–61.

22. Adachi B. Adachi B, editor. [Three branches of the femoral artery]. [The arterial system of the Japanese]. Kaiserlich-Japanischen Universtӓt zu Kyoto;1928. p. 147–53. German.

23. Massoud TF, Fletcher EW. 1997; Anatomical variants of the profunda femoris artery: an angiographic study. Surg Radiol Anat. 19:99–103. DOI: 10.1007/BF01628133. PMID: 9210243.

24. Tansatit T, Wanidchaphloi S, Sanguansit P. 2008; The anatomy of the lateral circumflex femoral artery in anterolateral thigh flap. J Med Assoc Thai. 91:1404–9. PMID: 18843871.

25. Boonkham Y, Plakornkul V. 1987; Variational anatomy of the profunda femoris artery in Thais. Siriraj Med J. 39:441–5.

26. Rajani SJ, Ravat MK, Rajani JK, Bhedi AN. Cadaveric study of lateral circumflex femoral artery. Int J Anat Radiol Surg. 2016; Apr. 12. [Epub]. https://doi.org/10.7860/IJARS/2016/20325.2134. DOI: 10.7860/IJARS/2016/20325.2134.

27. Wong TL, Kikuta S, Iwanaga J, Tubbs RS. 2019; A multiply split femoral nerve and psoas quartus muscle. Anat Cell Biol. 52:208–10. DOI: 10.5115/acb.2019.52.2.208. PMID: 31338239. PMCID: PMC6624330.

28. Tzouma G, Kopanakis NA, Tsakotos G, Skandalakis PN, Filippou D. 2020; Anatomic variations of the deep femoral artery and its branches: clinical implications on anterolateral thigh harvesting. Cureus. 12:e7867. DOI: 10.7759/cureus.7867. PMID: 32489722. PMCID: PMC7255544.

29. Balachandra N, Prakash BS, Padmalatha K, Ramesh BR. 2011; Variation in the origin of the lateral circumflex femoral artery: a case report. Anat Karnataka. 5:76–80.

30. Suder E, Nizankowski C. 1985; Variations in the origin of the deep femoral arteries in human fetuses. Folia Morphol (Warsz). 44:262–9. PMID: 3836190.

31. Kim H, Nam YS, Kim YS. 2021; The ascending branch of the lateral circumflex femoral artery penetrating the posterior division of the femoral nerve. Anat Cell Biol. 54:124–7. DOI: 10.5115/acb.20.237. PMID: 33536351. PMCID: PMC8017448.

32. Zlotorowicz M, Czubak-Wrzosek M, Wrzosek P, Czubak J. 2018; The origin of the medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery. Surg Radiol Anat. 40:515–20. DOI: 10.1007/s00276-018-2012-6. PMID: 29651567. PMCID: PMC5937904.

33. Saadeh FA, Haikal FA, Abdel-Hamid FA. 1998; Blood supply of the tensor fasciae latae muscle. Clin Anat. 11:236–8. DOI: 10.1002/(SICI)1098-2353(1998)11:4<236::AID-CA2>3.0.CO;2-P. PMID: 9652537.

34. Vazquez MT, Murillo J, Maranillo E, Parkin I, Sanudo J. 2007; Patterns of the circumflex femoral arteries revisited. Clin Anat. 20:180–5. DOI: 10.1002/ca.20336. PMID: 16617441.

35. Choi SW, Park JY, Hur MS, Park HD, Kang HJ, Hu KS, Kim HJ. 2007; An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap. J Craniofac Surg. 18:866–71. DOI: 10.1097/scs.0b013e3180a03304. PMID: 17667679.