Gross Anatomy
Variation in the origin of the Lateral circumflex femoral artery – A Case Report
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Balachandra N , Prakash B S , Padmalatha K , Ramesh B R
Dr. B.R. Ambedkar Medical College
side - The lateral circumflex femoral artery was
seen arising from the femoral artery, proximal to
the origin of the profunda femoris artery. In
addition another lateral branch was seen arising
from the profunda femoris artery making it
double lateral circumflex femoral artery on the
right side. (Diagram-1). On the left side – The
lateral circumflex femoral artery was seen arising
from the femoral artery at the level of profunda
femoris artery (Diagram-2).
ABSTRACT
Variations in the origin of the lateral circumflex
artery have been reported but most of them are
unilateral. These variations may be due to the
divergence in the mode and proximo distal level
of branching or aberrant vessels that connect with
principal vessels, arcades or plexuses. Here we
report a case of bilateral variation in the origin of
the lateral circumflex femoral artery. Knowledge
of the variations of the lateral circumflex artery is
important when undertaking clinical procedures
in the femoral region and hip joint replacements.
It can be used as an anterolateral thigh flap and in
CABG. Lateral circumflex femoral artery flap is
used for the reconstruction of large defects in the
face, secondary to gunshot wounds.
DISCUSSION
Normally, the lateral circumflex femoral artery
takes its origin from the lateral side of the
profunda femoris artery, passes in between the
anterior and posterior divisions of the femoral
nerve before dividing into ascending, transverse
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and descending branches . Hollinshead reports
that the lateral circumflex femoral artery arises
from the femoral artery in 15% of cases proximal
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to the Profunda femoris artery .
KEY WORDS
Femoral artery, Profunda femoris artery,
Lateral circumflex femoral artery, femoral nerve.
INTRODUCTION
Bergman et al have reported cases of double
lateral circumflex femoral artery, one from the
femoral artery and the other from the profunda
femoris artery. They have also reported that the
lateral circumflex femoral artery can be made up
of a number arteries represented by a common
stem and also have reported the origin of the
obturator artery from the lateral circumflex
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femoral artery . Vasquez et al have classified
medial and lateral circumflex femoral arteries
into 3 patterns. In Pattern 1 both the arteries arose
from the profunda femoris artery in78.8% of 346
cases. This pattern was more frequent in females.
They didn’t find any significant difference
between the sides. They sub classified this pattern
Lateral circumflex femoral artery is a lateral
branch of the profunda femoris artery near the
latters’ root. It passes laterally between the
anterior and posterior divisions of the femoral
nerve posterior to the Sartorius and rectus femoris
muscles and divides into ascending, transverse
and descending branches which supply the greater
trochanter, hip joint and the anterolateral thigh
1
fasciocutaneus flap respectively.
Case Report
In an adult female cadaver, the lateral
circumflex femoral artery was seen arising from
the femoral artery, on both sides. On the right
side - The lateral circumflex femoral artery was
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Anatomica Karnataka, Vol-5, (1) Page 76-80 (2011)
Gross Anatomy
Variation in the origin of the Lateral circumflex femoral artery – A Case Reportl
Diagram-1: shows Right femoral triangle in which two lateral circumflex arteries can be seen
arising from femoral artery and Profunda femoris artery respectively.
Femoral vein
Femoral artery
Profunda Femoris artery
Femoral nerve
Lateral circumflex femoral
artery
Lateral circumflex
femoral artery
Diagram – 2: Shows left femoral triangle in which the lateral circumflex femoral artery is seen
arising from the femoral artery at the level of the origin of the profunda femoris artery.
Profunda femoris artery
Femoral artery
Femoral nerve
Lateral circumflex
femoral artery
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Anatomica Karnataka, Vol-5, (1) Page 76-80 (2011)
Variation in the origin of the Lateral circumflex femoral artery – A Case Reportl
between the sides. They sub classified this pattern
as 1a, 1b and 1c .Of these in 1a the origin of the
medial circumflex femoral artery was proximal to
that of that of Lateral circumflex femoral
artery(53.2%) while in 1b it was reversed(23.4%)
and in 1c both arose from a common
trunk(23.4%). In pattern 2 one of these arteries
arose from the femoral artery while the other from
the profunda femoris artery. This pattern also has
2 subtypes, 2a and 2b. In 2a the medial circumflex
femoral artery arose from the femoral artery
(77.8%) while in 2b the lateral circumflex femoral
artery arose from the femoral artery (22.2%). In
pattern 3 both arose from the femoral artery
(0.5%). They have observed that in every
disposition there was a significantly higher
prevalence of unilateral than bilateral occurrence.
The knowledge of these variations is of
importance when clinical procedures are
undertaken in the femoral region and in hip joint
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replacements . Ercan Tanyeli has reported the
origin of the lateral circumflex femoral artery
from the femoral artery distal to the profunda
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femoris artery . Marina Baptist et al have reported
the origin of the lateral circumflex artery from the
femoral artery. They have also reported that the
profunda femoris artery and its branches are
encountered during femoral artery cannulation
for various clinical and diagnostic procedures;
hence knowledge of these variations is useful to
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prevent haemorrhagic accidents . Cristina Evans
has found both medial and lateral circumflex
femoral arteries arising by a common trunk from
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the femoral artery . M Uzel et al have studied 110
inguinal regions (55 cadavers). They have found
that the lateral circumflex femoral artery arose
from profunda femoris artery in 85 cases (77.3%),
from the femoral artery in 21 cases (19.1%). They
have also found a common trunk from where the
Gross Anatomy
profunda femoris artery and the lateral circumflex
arteries were taking origin in 1 case (0.9%) and
another common trunk for profunda femoris
artery, medial circumflex femoral artery and
lateral circumflex femoral artery in1 case (0.9%).
They have found the ascending and descending
branches of the lateral circumflex artery to be
arising from the femoral artery and the profunda
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femoris artery respectively in 2 cases (1.8%) .
Hisayo Nasu and Shogi Chiba have reported the
origin of the medial and lateral circumflex
femoral arteries from common trunk on the right
side and medial circumflex femoral, inferior
epigastric and obturator arteries arising from a
common trunk on the left side of an 83 yr. old
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cadaver . Rui Fernandes and Jason Lee have
reported the successful use of the lateral
circumflex femoral artery perforator flap as a
reliable option for the immediate reconstruction
of large defects secondary to gunshot wounds of
the face. The lateral circumflex femoral artery
perforator flap is at a site which is not involved in
the immediate resuscitation of trauma patients,
thus ensuring an intact vascular system. This fact
makes the lateral circumflex femoral artery
perforator flap a reliable source for small to large
soft tissues for reconstructing avulsive soft tissue
10.
losses in the head and neck Yasuhiko Sugawara
et al have reported the successful utilization of the
lateral circumflex femoral artery as a midway
outflow for aorto-lateral-circumflexfemoropopliteal artery sequential bypass on a
patient with total occlusion of all major arteries in
11.
the unilateral iliofemoral region The descending
branch of the lateral circumflex femoral artery has
been used as a high flow conduit for extra cranial12.
intracranial bypass surgery successfully
The anomalous patterns of lateral circumflex
femoral artery may be due to –
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Anatomica Karnataka, Vol-5, (1) Page 76-80 (2011)
Variation in the origin of the Lateral circumflex femoral artery – A Case Reportl
1. Divergence in the mode and proximodistal
level of branching.
Gross Anatomy
Miyayichi ; Compendium of Human Anatomic
variations ; Urban & Schwarzenberg, Baltimore Munich 1988, pp. 86-87.
2. Presence of unusual compound arterial
segments.
4. Vasquez M T, Murillo J, Maranillo E, Parkin I,
Sanudo J ; Patterns of the circumflex femoral
arteries revisited ; Clinical Anat 2007. Mar 20(2):
180-185.
3. Aberrant vessels that connect with principal
vessels, arcades or plexuses
4. Vessels that occupy exceptional tissue planes
(e.g. superficial fascia instead of sub fascia).
5. E Tanyeli, M Yildirim, M Uzel & F Ural ;
Deep Femoral artery with 4 variations – A case
report, Surg & Radiol Anat ; May 2006:28; (2),
211-213.
5. Have unsuspected neural mycological or
1
osteoligamentous relationships .
CONCLUSION
6. M Baptist, F Sultana & T Hussain Anatomical
variation the origin of Profunda Femoris artery,
its branches and diameter of the Femoral artery,
Professional Med J ; Sep 2007; 14(3) :523-527.
Origin of the lateral circumflex femoral artery
from the femoral artery has been reported quite
frequently and most of it is unilateral but bilateral
occurrence with double lateral circumflex
femoral artery on one side is very uncommon,
which is the present case. Knowledge of these
variations is important when undertaking clinical
procedures within the femoral region and in hip
4
joint replacement . Lateral circumflex femoral
artery is used as a perforator flap in the
10
reconstruction of gunshot wounds . It can be
8
used as an anterolateral thigh flap . Its branches
11
are used for aortopopliteal bypass , coronary
8
artery bypass surgery . Profunda femoris artery
and its branches are encountered during femoral
artery cannulation for various clinical and
6
diagnostic techniques . The descending branch of
the lateral circumflex femoral artery can be used
as a high flow conduit for extracranial 12
intracranial bypass surgery
7. Cristina A Evans, Kent S Smith & L Jarolim;
Observations of 2 uncommon variations of
proximal branches of Femoral artery; The Faseb
Journal, 2007; 776.11.
8. M Uzel, E Tanyeli , Yildirim M Anatomical
study of the origin of Lateral circumflex femoral
artery in Turkish population Folia Morphol 2008;
vol 67, no 4, pp.226-30.
9. H Nasu & S Shiba Rare case of Femoral
artery ramification and origin of Obturator artery,
Anatomy Science International ; March 2009, vol
84(4), 323-326.
10. Rui Fernandes, Jason Lee . The use of Lateral
circumflex femoral artery perforator flap in the
Reconstruction of gunshot wounds of the face,
Journal Oral & Maxillofacial surgery ; October
2007; vol 65, Issue 10, pp.1990-1997.
.
REFERENCES
11. Yasuhiko Sugawara, et al; Utilization of
Lateral circumflex artery as Midway Outflow for
Aortopopliteal grafting: Report of a case Surgery
Today. 1998. Vol 28, (9) pp. 967-970.
1. Susan Standring, Gray’s Anatomy; The
th
Anatomical Basis of Clinical practice, 40 edn,
Elsivier Churchill Livingstone; 2005. pp.1480.
rd
2. W Henry Hollinshead TB of Anatomy, 3 edn,
Harper & Row, 1974,pp.407.
12. Baskaya M K, Kiehn M W, Ahmed A S, Ates
O, Niemann D B; Alternative vascular graft for
extracranial-intracranial bypass surgery:
3. Ronald A Bergman, Adel K Afifi, Ryosuke
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Anatomica Karnataka, Vol-5, (1) Page 76-80 (2011)
Variation in the origin of the Lateral circumflex femoral artery – A Case Reportl
Gross Anatomy
descending branch of lateral circumflex femoral
artery; Neurosurgical Focus 24(2): E8,2008.
Address for Communication
Dr. Balachandra N
Assistant Professor, Dept. of Anatomy,
Dr. B. R. Ambedkar Medical College,
Kadugondanahalli, Bengaluru.
Ph: 9886592995.
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Anatomica Karnataka, Vol-5, (1) Page 76-80 (2011)