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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Lower Limb: Popliteal Artery

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Arteries: Lower Limb

Popliteal Artery

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed

Bardsley and Staple report variations in the branches of the popliteal occurred in 7.2% of 235 limbs. The small number of variations are, nonetheless, clinically significant. If the branching pattern is "normal" (usual) in one limb, there is an 8% chance that the contralateral limb will have a variant. If one limb has a variant there is a 50% chance that the other limb will also be variable.

Bardsley and Staple also found a "normal" (usual) level of termination and branching in 92.8% of 235 limbs, high division of the popliteal artery in 4.2%, high division with the peroneal arising from the anterior tibial in 1.7%, trifurcation of popliteal in 0.4%, and absence of the posterior tibial in 0.9%.

The authors further reported variation of the pattern between limbs in the same subject. When the pattern was the same in both limbs, the usual level of termination and branching occurred in 86.2%, high division of the popliteal artery occurred in 3.8%, and the absence of the posterior tibial occurred in 1.3%. A different pattern in each leg occurred in 8.7%. In most instances, a high division with the peroneal arising from the anterior tibial occurred more frequently on the right side and the so-called "normal" (usual) pattern and the high division of the popliteal occurred on the left side.

The principal variations of the popliteal artery are as follows:
The popliteal artery may divide higher or, more rarely, lower than usual. It may divide into the anterior tibial, posterior tibial, and peroneal, or into a posterior tibial and a common trunk for the anterior tibial and peroneal. If the peroneal artery arises from the anterior tibial artery, there is usually a high bifurcation of the popliteal artery.

The popliteal vein may be deeper than the artery or separated from it by a slip of the gastrocnemius muscle (a third head of the gastrocnemius). A third head of the gastrocnemius is the most common variation of the gastrocnemius muscle and there are several varieties of the third head. These variations of the gastrocnemius may compromise the function of one or more of the popliteal artery, vein, or nerve. See illustration in either the muscle section of this encyclopedia or following this discussion.

The popliteal is sometimes a continuation not of the femoral but of a sizable ischiadic (sciatic) artery.

Unusual branches of the popliteal include an ascending branch to hamstring muscles, anastomosis with one of the perforating femorals, an aberrant artery that descends to the popliteal ligament and then reunites with the popliteal artery, an accessory posterior tibial, and a branch to the gastrocnemius (where it may form a ring around the tibial nerve). The articular branches to the knee are variable.

The popliteal occasionally provides a small saphenous artery (arteria saphena parva) that courses with the vein of the same name and the sural nerve to the tarsus.

The popliteal artery usually passes over the popliteal muscle and between the lateral and medial heads of the gastrocnemius muscle. Entrapment and compression of the popliteal artery may occur whenever its course is altered, for example, when it passes beneath the popliteus muscle or some part of the gastrocnemius muscle, usually the medial head, which may also be variable in having a third head.

The popliteal artery has been seen taking an irregular course and passing through the medial head of the gastrocnemius (Labatt, 1837; Croft, 1861; Franck [Francois], 1873; Terrier, 1873; Stuart, 1878; Davidson, 1890).

A very interesting historical review has been given by Rich, et al., 1979. A quotation from the Rich et al. paper follows, " T.P. Anderson Stuart during his medical school years in Edinburgh dissected an amputated leg of a 64-year old man in 1879 and described the popliteal artery as that which... passes almost vertically downwards internally (medially) to the inner (medial) head of the gastrocnemius. It reaches the bottom of the space by turning round the inner border of that head, and then passes downwards and outwards beneath it.... This was recognized as a variation that had not been previously recorded. It was not until an additional 80 years had passed, however, when Hamming at Lyden University in the Netherlands in 1959 reported a similar variation in a 12-year old Dutch boy. Hamming gave credit to the initial report of Stuart and also acknowledged that Dubreuil-Chambardel in 1925 had described a case in which the course of the popliteal artery was separated from the popliteal vein by an accessory slip of the gastrocnemius muscle".

Quain (1844) reported the popliteal to be doubled, 10 times in 227 cases studied. Quain doubted that the artery could be doubled above the knee joint, but this was disproved by four authors who followed him (Dean, 1880; Collins, 1868; Mackay, 1889; and Croft, 1861).

All terminal branches may arise from a single stem (Withers, 1890).

Otto (1824) reported a large branch passed upward to anastomose with the last perforating artery.

Image 131, Image 225, Image 242, Image 366, Image 429, Image 431, Image 461, Image 462, Image 463

Images 507


Image 100, Image 399


Arnold, G. (1968) Seltene Gefass, und Muskalanomalien am bein. Anat. Anz. 123:471-475

Amici, Jr., F. (1965) Un raro caso di decorso anomalo con ostruzione trombotica dell'arteria poplitea. Minerva Ortopedica. 16:427-429.

Anson, B.J., Ed. (1966) Morris' Human Anatomy, 12th ed., McGraw-Hill Book Company, New York.

Bardsley, J.L. and T.W. Staple (1970) Variations in branching of the popliteal artery. Radiology 94:581-587.

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Bergman, R.A., Thompson, S.A., Afifi, A.K. and F.A. Saadeh. (1988) Compendium of Human Anatomic Variation: Catalog, Atlas and World Literature. Urban & Schwarzenberg, Baltimore and Munich.

Bergman, R.A., Walker, C.W. and G.Y. El-Khoury (1995) Gastrocnemius tertius in CT images. Annals Anat. 177:291-294.

Biemans, R.G.M. and J.H. van Bockel. (1977) Popliteal artery entrapment syndrome. Surg., Gynecol. Obstet. 144:604-609.

Blair, Jr., C.B. and K. Nandy. (1965) Persistence of the axis artery of the lower limb. Anat. Rec. 152:161-172.

Bouhoutsos, I. and A. Goulios. (1977) Popliteal artery entrapment: Report of a case. J. Cardiovascular Surgery 18:481-484.

Broca, -. (1849) Cinq anomalies artérielles sur le même subject. Anomalies rare des artères de l'avant--bras. Reflexions sur les anomalies artérielles du member thoracique (popliteal, renales, deux arteres humérals, femoral, tibio-peronier tronc). Bulletins et Mem. de la Société Anatomique de Paris XXIV(2):49-59.

Carter, A.e. and R. Eban. (1964) A case of bilateral developmental abnormality of popliteal arteries and gastrocnemius muscles. Br. J. Surg. 51:518-522.

Darling, R.C., Buckley, C.J., Abbott, W.M., et al. (1974) Intermittent claudication in young athletes: Popliteal artery entrapment syndrome. J. Trauma 14:543-552.

Dean, M.H. (1880) Arterial anomalies. The Medical Record, N.Y. 17:384.

Delaney, T.A. and L.L. Gonzales (1971) Occlusion of popliteal artery due to muscular entrapment. Surgery 69:97-101.

Devin, R., Salavert, J.P. et P. Dor. (1969) Malposition et stenose extrinseque de l'artère poplitée par anomalie d'insertion du jumeau interne. Mem. Acad. Chir. 95:752-754.

Dubreuil-Chambardel, L. (1925) Variations des Arteries du Pelvis et du Membre Inferieur. Masson, Paris.

Edmondson, H.T. and J.A. Crowe, Jr. (1972) Popliteal artery and venous entrapment. Am. Surg. 38:657-659.

Fano, -. (1848) Anomalie des artères de la jambbe. Bulletins et Mem. de la Société Anatomique de Paris XXIII(1-3):32.

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Féré, Ch. (1878) Anomalie de l'artère poplitée, l'artere poplitée droit passé en arrière de la veine. Bulletins et Mem. de la Société Anatomique de Paris LIII(1):49.

Ferrero, R., Barile, C., Buzzacchino, A., et al. (1978) La sindrome da costrizione dell'arteria poplita. Minerva Cardioangiology 26:389-410.

Fontanetta, A.P., Kirshbom, E., Fisher, M.M., et al. (1974) Popliteal artery entrapment: Lateral deviation and compression of artery. Vasa 3:399-403.

Gruber, W. (1875) Anomaler Verlauf der Arteria poplitea durch den Sulcus popliteus internus und Obliteration derselben auf diesem Umwege. Arch. Pathol. Anat. Physiol. Klin. Med. 65:262-270.

Gruber, W. (1878) Hohe Theilung der Arteria poplitea in die A. tibialis postica und in den Truncus communis für die A. peronea und die A. tibialis antica, mit Endigung der A. tibialis postica als A. plantaris interna und der peronea als A. plantaris externa. Arch. Pathol. Anat. Physiol. Klin. Med. 74:438-443.

Haimovici, H., Sprayregen, S. and F. Johnson. (1972) Popliteal artery entrapment by fibrous band. Surgery 72:789-792.

Hall, K.V. (1961) Anomalous insertion of the medial gastrocnemic head, with circulatory complications. Acta Pathol. Microbiol. Scand. 148 (Suppl.):53-58.

Hall, K.V. (1964) Intravascular gastrocnemius insertion. Acta Chir. Scand. 128:193-196.

Hamming, J.J. (1959) Intermittent claudication at an early age, due to an anomalous course of the popliteal artery. Angiology 10:369-371.

Hamming, J.J. and M. Vink. (1965) Obstruction of the popliteal artery at an early age. J. Cardiovascular Surgery 6:516-524.

Jacques, P. (1895) Quelques anomalies artérielles (sous-clavière droite, tronc coeliaque, poplitée). Bull. et Mem. de la Soc. Anatomique de Paris. 70:252-255.

Joffe, N. (1964) Aneurysm of a persistent primitive sciatic artery Clin. Radiol. 15:286-290.

Kubota, K., Haibara, T. and M. Noguchi. (1958) A case of bilateral existence of ischiadic artery in man. Folia Anat. Jpn. 30:339-340.

Laubach, K., Trede, M., Perera, R., et al. (1973) Das kompressionssyndrome der arteria poplitea. Chirurg. 44:74-77.

Love, J.W. and T.J. Whelan. (1965) Popliteal artery entrapment syndrome. Am. J. Surg. 109:620-624.

Manno, A. (1907) Sur une varieté d'arteria ischiatica chez l'homme. Arch. Ital. Biol. 47:487.

Pernkoff, E. (1922) über einen Fall von beiderseitiger Persistenz der Arteria ischiadica. Anat. Anz. 55:536-542.

Pierson, H.H. (1925) Seven arterial anomalies of the human leg and foot. Anat. Rec. 30:139-145.

Poynter, C.W.M. (1922) Congenital anomalies of the arteries and veins of the human body with bibliography. University Studies of the University of Nebraska. 22:1-106.

Rich, N.M. and C.W. Hughes (1967) Popliteal artery and vein entrapment. Am. J. Surg. 113:696-698.

Rich, N.M., Collins, G.J., McDonald, P.T., Kozloff, L., Clagett, G.P. and J.T. Collins. (1979) Popliteal vascular entrapment. Its Increasing Interest. Arch. Surg. 114:1377-1384.

Sackler, J.P., Abrams, B.M. and E.R. Beranbaum. (1968) Congenital absence of the anterior tibial artery. Angiology 19:67-74.

Schulze-Bergman, G. (1972) Zum kompressionssyndrom der arteria poplitea. Vasa 1:186-191.

Senior, H.D. (1919) The development of the arteries of the human lower extremity. Am. J. Anat. 25:55-94.

Senior, H.D. (1929) Abnormal branching of the human popliteal artery. Am. J. Anat. 44:111-119.

Shepherd, F.J. (1882) On some anatomical variations: high division of the popliteal. Annals of Anatomy and Surgery. 6:171.

Stieda di Königsberg, -. (1895-1896) Un paragone fra le arterie dell'avambraccio e quelle della gamba. Giornale della Associazione Napoletana di Medici e Naturalisti 5:157-166.

Stuart, T.P.A. (1879) Note on a variation in the course of the popliteal artery. J. Anat. Physiol. 13:162.

Terrier, -. (1873) Disposition anormale des jumeaux de la jambe et de l'artère poplitée. Bull. de la Soc. de Chirurgie de Paris 2:115-126.

Terrier, M. (1873) Disposition anormale des jumeaux de la jambe et de l'artère poplitée. Gazette des Hôpitaux 46:317.

Trotter, M. (1940) Level of termination of popliteal artery in White and Negro. Am. J. Phys. Anthropology 27:109-118.

Wright, F.W. (1964) Persistent axial or sciatic artery of the lower limb in association with hemihypertrophy. Clin. Radiol. 15:291-292.

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