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The common femoral artery is a continuation of the external iliac artery and is approximately 4 cm long. It begins directly behind the inguinal ligament, midway between the anterior superior iliac spine and the symphysis pubis.
The profunda femoris artery arises from the lateral aspect of the common femoral artery, towards the femur, approximately 3–4 cm below the inguinal ligament. The common femoral artery continues obliquely down the anteromedial aspect of the thigh as the superficial femoral artery.
The superficial femoral artery exits the femoral triangle to enter the subsartorial canal and ends by passing through an opening in the adductor magnus to become the popliteal artery.
In the upper third of the thigh, the femoral vessels are contained within the femoral triangle (Scarpa’s triangle).
The femoral triangle is formed laterally by the medial border of the sartorius muscle, medially by the adductor longus, and superiorly by the inguinal ligament.
In the femoral triangle, the femoral vein lies medial to the femoral artery. The greater saphenous vein drains into the femoral vein about 3–4 cm below the inguinal ligament; further distally, the femoral vein lies posterior to the artery and maintains this relationship in the popliteal fossa. The femoral nerve and its branches are found lateral to the common femoral artery.
In the middle third of the thigh, the femoral artery lies within the adductor canal (Hunter’s canal), an aponeurotic tunnel in the middle third of the thigh that extends from the apex of the femoral triangle to the opening in the adductor magnus.
The adductor canal is bounded by the sartorius muscle anteriorly, the vastus medialis laterally, and the adductor longus and magnus posteromedially. A fascial plane between the vastus medialis and adductor longus and magnus covers the canal.
The canal contains the femoral artery and vein, the saphenous nerve which crosses from lateral to medial, and branches of the femoral nerve.
The femoral vein courses from a medial position in the groin to a posterior and then lateral position with respect to the artery as it moves distally towards the knee.
The greater saphenous vein courses medially to lie on the anterior surface of the thigh, before entering the fascia lata and joining the common femoral vein at the sapheno-femoral junction near the femoral triangle.
The right common carotid artery originates from the innominate (brachiocephalic) artery. The external landmark is the right sternoclavicular joint. The left common carotid artery originates directly from the aortic arch in the superior mediastinum.
The carotid sheath contains the common and internal carotid arteries, the internal jugular vein, and the vagus nerve. The internal jugular vein lies lateral and superficial to the common carotid artery and vagus nerve. The vagus nerve lies posteriorly, between the artery and the vein. On occasion the vagus nerve may be located anterior to the vessels.
The carotid sheath and its contents are covered superficially by the platysma, anterior margin of the sternocleidomastoid muscle, and the omohyoid muscle. Deep to the vessels are the longus colli and longus capitis muscles. Medial to the carotid sheath is the esophagus and trachea.
At the level of the superior border of the thyroid cartilage, the common carotid artery bifurcates into the internal and external carotid arteries.
The facial vein crosses the carotid sheath superficially to enter the internal jugular vein at the level of the carotid bifurcation.
The external carotid artery lies medial to the internal carotid artery for the majority of their course. The first branch of the external carotid artery is the superior thyroid artery located near the carotid bifurcation.
The internal carotid artery does not have any extracranial branches.
At the level of the angle of the mandible, the internal and external carotid arteries are crossed superficially by the hypoglossal nerve (Cranial Nerve XII) and the posterior belly of the digastric muscle. The glossopharyngeal nerve (Cranial Nerve IX) passes in front of the internal carotid artery, above the hypoglossal nerve.
The external carotid arteries terminate in the parotid gland, where they divide into the superficial temporal and maxillary arteries.
At the level of the skull base, the internal carotid arteries cross deep and medial to the external carotid arteries to enter the carotid canal behind the styloid process.
The pancreas lies transversely in the retroperitoneum, at the L1–L2 vertebral level, between the duodenum and the hilum of the spleen.
The head of the pancreas lies over the inferior vena cava (IVC), right renal hilum, and the left renal vein at its junction with the IVC.
The uncinate process extends to the left and wraps from around the superior mesenteric vessels. It is in close proximity to the inferior pancreaticoduodenal artery.
The neck of the pancreas lies over the superior mesenteric vessels and the proximal portal vein. The space between the neck and the superior mesenteric vessels is avascular and allows blunt dissection without bleeding. The area to either side of the midline is vascular and should be avoided.
The body of the pancreas lies over the suprarenal aorta and the left renal vessels. It is intimately related to the splenic artery and vein.
The major pancreatic duct (Wirsung) traverses the entire length of the pancreas and drains into the ampulla of Vater, approximately 8 cm below the pylorus. The lesser duct of Santorini branches off the superior aspect of the major duct, at the level of the neck of the pancreas, and drains separately into the duodenum, approximately 2–3 cm proximal to the ampulla of Vater.
The pancreas receives its blood supply from both the celiac artery and the superior mesenteric artery.
The head of the pancreas and the proximal part of the duodenum receive their blood supply from the anterior and posterior pancreaticoduodenal arcades. These arcades lie on the surface of the pancreas, close to the duodenal loop. Any attempts to separate the two organs results in ischemia of the duodenum.
The body and tail of the pancreas receive their blood supply mainly from the splenic artery. The splenic artery originates from the celiac artery and courses to the left along the superior border of the pancreas. It follows a tortuous route, with parts of it looping above and below the superior border of the pancreas. It gives numerous small and short branches to the body and tail of the pancreas.
The splenic vein courses from left to right, superiorly and posteriorly to the upper border of the pancreas, inferiorly to the splenic artery. It is not tortuous like the artery. It joins the superior mesenteric vein, at a right angle, behind the neck of the pancreas, to form the portal vein. The inferior mesenteric vein crosses behind the body of the pancreas and drains into the splenic vein.
The portal vein is formed by the junction of the superior mesenteric and splenic veins, in front of the inferior vena cava and behind the neck of the pancreas.
The common bile duct (CBD) courses posterior to the first part of the duodenum, in front of the portal vein, continues behind the head of the pancreas, often partially covered by pancreatic tissue, and drains into the ampulla of Vater, in the second part of the duodenum.