Descriptive anatomic study of the fourth perforating artery of the femoralsystem

The existence of the fourth perforating artery of Paturet [7], a collateral branch of the superficial femoral artery in its lower third, is the subjec t of much debate. This artery has so far only been the subject of radio-ana tomic descriptions based on arteriographies carried out within the context of arteriopathy of the lower Limbs. We present a descriptive anatomic study of this artery based on 14 observations on 32 dissections. Three types of approach were carried out: exposure of the artery of the femoral quadriceps muscle up to its ending in the vastus lateralis; a lateral "orthopaedic" a pproach to the lower third of the femur; and a "vascular" approach by a med ial incision to the femoro-popliteal axis in the lower third of the thigh. Its main relations are described, passing in front of the superficial femor al vein and then behind the femur before ending at the vastus lateralis mus cle. These relations explain the possibility of anastomoses with collateral or terminal branches of the deep femoral artery (vastus lateralis artery, third perforating artery). The fourth perforating artery of Paturet [7] mus t be protected in traumatologic and vascular surgery. It is the main collec tor of vascular anastomoses between the deep femoral artery and the femoro- popliteal axis in the event of proximal occlusion of the superficial femora l artery. Its removal, in such a case, can aggravate an underlying arteriop athy.