The origin of the medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery

Abstract

Introduction: The most significant blood vessel supplying the hip joint is the medial femoral circumflex artery (MFCA). MFCA with lateral femoral circumflex artery (LFCA) are the first branches of the deep femoral artery (DFA) or they originate directly from the common femoral artery (CFA) or superficial femoral artery (SFA).

Purpose and methods: We analyzed 100 CT angiogram of the hip region [72 men, 28 women; mean age 46.4 (14-80)] to assess the frequency of each type of division of the MFCA and LFCA from either the DFA or directly from the CFA or SFA. To assess the variations on each side in one individual we analyzed both hips in 73 patients [mean age 46.6 (14-80)].

Results: Many different types of division have been described. The most frequent one in which both the MFCA and LFCA originate from the DFA, was observed in 50% of patients. In 31% of hips the MFCA originates from the CFA. In our study, a normal origin of the obturator artery from the internal iliac artery was observed in 67% of patients and an atypical origin, called corona mortis was observed in 33% of patients.

Conclusions: The deep branch of the MFCA is the main artery supplying the femoral head, it is at risk during surgical approach to the hip joint. The atypical anastomosis called corona mortis is also at risk while performing the approach to pubic bone. Therefore, knowledge of their topography is very important.

Keywords: Corona mortis; Deep femoral artery; Femoral artery; Lateral femoral circumflex artery; Medial femoral circumflex artery; Obturator artery.

Fig. 1

The volume rendering transformation of the angio CT examination of the truncus profundocircumflexus perfectus, MFCA (1), LFCA (2), deep femoral artery (arrow)

Fig. 2

a Truncus profundocircumflexus lateralis type A, MFCA (1) originates from the common femoral artery (arrow), LFCA (2) originates from the deep femoral artery. b Truncus profundocircumflexus lateralis type B, MFCA(1) originates from the superficial femoral artery (arrow), LFCA (2) originates from the deep femoral artery

Fig. 3

a Truncus profundocircumflexus medialis type A LFCA (2) originates from the common  femoral artery (white arrow), MFCA (1) from the deep femoral artery (black arrow). b Truncus profundocircumflexus medialis type B LFCA (2) originates from the superficial femoral artery (white arrow), MFCA (1) from the deep femoral artery

Fig. 4

a MFCA (1) and LFCA (2) originate from common femoral artery (arrow). b MFCA (1) and LFCA (2) originate as one common trunk from the common femoral artery (black arrow) before the division (white arrow) into deep femoral artery and superficial femoral artery

Fig. 5

A case with no MFCA with an atypical obturator artery (1), LFCA (2) (a), in comparison with a case with a high level of division of the MFCA (1) directly from the common femoral artery located above the level of the pubic bone (b), the third case, with both arteries, represents an atypical obturator artery (2) and an MFCA (1) arising directly from the  common femoral artery (c)