The femoral artery is the main artery of lower limb. It is the continuation of external iliac artery.  It begins behind the mid-inguinal point and descends along the anteromedial aspect of thigh in the femoral triangle. At the apex of the triangle, it enters the adductor canal; then it passes through the hiatus magnus and continues as popliteal artery.1

The femoral artery gives off superficial and deep branches in the femoral triangle. The superficial branches are superficial epigastric, superficial circumflex iliac and superficial external pudendal. The deep branches are deep external pudendal and profunda femoris artery which in turn gives off medial circumflex femoral and lateral circumflex femoral artery.1

Femoral artery is important as it is widely used in clinical procedures like arterial catheterization, coronary angioplasty, embolectomy in lower limb arterial thromboembolism.2

Deep external pudendal artery:

 The deep external pudendal artery passes medially across pectineus and anterior or posterior to adductor longus, covered by fascia lata which it pierces to supply the skin of the perineum and scrotum or labium majus. Its branches anastomose with the posterior scrotal or labial branches of the internal pudendal artery.

The DEPA passes medially, supplying the skin of the perineum, scrotum, or labium majus. This artery and its perforating branches have gained significant clinical attention, particularly in plastic and reconstructive surgery, where they serve as a critical component in perineal reconstructions utilizing perforator flaps. Furthermore, the location of the DEPA, typically arising lower than the superficial arteries, is an important anatomical landmark for clinicians performing procedures in the groin area.3 This study aims to precisely document the morphometric and variational anatomy of the DEPA in a cadaveric population to enhance the anatomical knowledge base for surgeons and interventional radiologists.

Objectives Of the Study

• To know the origin and variations in branching pattern of deep external pudendal artery in femoral triangle.
• To know the distance of origin from midinguinal point and side of origin of deep external pudendal artery in femoral triangle

Source of data:

The 40 lower limbs specimens for this study were obtained from the Department of Anatomy, during the course of study over a period of two years.

Inclusion criteria: 

All the cadavers available during study period were included.

Exclusion criteria:

Deformed or traumatized lower extremities were excluded from the study.

Materials :

1. Scalpel and scissor                 Blunt, sharp and toothed forceps
2. Measuring tape and scale    4. Photography kit

Methods:

Dissection method:   Dissection was done on 40 lower limbs from embalmed cadavers allotted for MBBS dissection in the Department of Anatomy.

Dissection of femoral artery and its branches was carried out according to Cunningham’s manual of practical anatomy. ⁴

Incision was taken on skin from pubic tubercle to the anterior superior iliac spine.  Another incision from pubic tubercle downwards and then vertically down to adductor tubercle.  Transverse incision from adductor tubercle to lateral side of thigh was done and skin flap was reflected laterally.

The superficial fascia and lymph nodes were cleared and superficial branches of femoral artery were identified and cleaned. Deep branches of femoral artery were identified and cleaned. Site of origin, distance of origin from midinguinal point and side of origin of all branches of femoral artery in femoral triangle were noted. The variations in the origin of deep external pudendal artery were noted.  Photograph of each specimen was taken after dissection, with digital camera.

Table-1a: Origin of DEPA

Table-1b: Distance of origin

Table-1c: Side of origin

In the present study, out of 40 specimens DEPA originated from femoral artery as a separate branch in 39 specimens (97.5%) and from the medical circumflex femoral artery in 1 specimen (2.5%) as showed in Table 1a: Origin of DEPA

The distance of origin of DEPA from the mid inguinal point was within 3 cm in 6 specimens (15%) and between 3.1 – 6 cm in 34 specimens (85%) as showed in Table 1b: Distance of origin

The DEPA arises from anterior side in 1 specimen (2.5%) and from medial side in 39 specimens (97.5%) as showed in Table 1c: Side of origin.

A study was conducted on 40 lower limbs of embalmed cadavers from Department of Anatomy. Femoral triangles were dissected and femoral artery with its branches in femoral triangle were traced. The origin, distance from the midinguinal point and side of origin of deep external pudendal arteries were noted.

Mamatha H. gives the following recordings in her study. Higher origin of the profunda femoris artery was seen in 5% of the cases, while deep external pudendal artery was arising at distance of 5 cm from the mid-inguinal point. The profunda femoris artery originated at about 4.5 cm from the mid inguinal point.5

The deep external pudendal artery arose from the medial circumflex femoral artery bilaterally.6

Variations in the branching pattern of the femoral artery can be linked to abnormal development of the arterial network in the embryo's pelvic limb. The axial artery of the pelvic limb comes from the fifth lumbar intersegmental artery. It is seen as a branch of the internal iliac artery and runs over the front of the thigh. The femoral artery travels along the underside of the thigh, creating a new pathway to the pelvic limb. It originates from a capillary network that connects to the branches of the external iliac artery at one end and to the axial artery at the other end. It is thought that the increased blood flow in these capillaries shapes the final mature arterial pattern. As a result, the most effective channels expand while others shrink and vanish . Therefore, the initial variations of the EPA can be understood through the arrangement of blood vessels supplying the external genitalia, where blood flow is heightened.7

In the present study, DEPA arises from the femoral artery as a separate branch in 39 specimens (97.5%) and from MCFA in one specimen (2.5%), which is rare in the history where as Nachiket Shankar mentions in his study that DEPA arose from the MCFA bilaterally.6

The distance of origin from midinguinal point ranges from 2.5 cm to 6 cm.  DEPA arose within 3 cm in 6 specimens (15%) and between 3.1 to 6 cm in 34 specimens (85%). Which was also mentioned by Mamtha H. in her study that DEPA was arising at distance of 5 cm from MIP.5 Hollinshed WH mentions that DEPA arises lower than the superficial arteries.8

In the present study, DEPA arises medially from femoral artery in 39 specimens (97.5%) and anteriorly in one specimen (2.5%) similar observation by Susan Standring that DEPA arises medially from femoral artery.1 Deep external pudendal artery was arising from profunda femoris instead of the femoral artery.9

The DEPA and its perforators are increasingly used as vascular pedicles for reconstructive flaps in the perineal region10. The predictable medial course but variable depth of origin should guide the dissection plane during flap harvest.

The Deep External Pudendal Artery (DEPA) exhibits a highly consistent origin from the medial side of the femoral artery (97.5%) at a mean distance of 4.12 cm from the mid-inguinal point. The low incidence of variation (2.5%) where the DEPA arose from the Medial Circumflex Femoral Artery is a vital anatomical detail. Detailed knowledge of these parameters is indispensable for surgeons and interventionalists working in the femoral triangle, as it guides safe surgical access and improves the success rate of complex reconstructive procedures

1. Susan Standring. Gray’s anatomy. The anatomical basis of clinical practice. 39^th ed, Edinburgh: Elsevier Churchill Livingstone; 2005.p.1451.
2. MB Samarawickrama, BG Nanayakkara, KWR Wimalagunarathna, DG Nishantha, UB Walawage. Branching pattern of the femoral artery at the femoral triangle: a cadaver study. Galle Medical Journal Sept.2009;14(1):31-34.
3. Osvaldir Lanzoni La Falce, Joao Dias Ambrosio, Romeu Rodrigues de Souza. The anatomy of the superficial external pudendal artery: a quantitative study.  Clinics Sao Paul Oct. 2006;61(5).
4. Romanes GJ. Cunningham’s manual of practical anatomy. Volume 1. 15th ed. Oxford: ELBS; 1992. Pp. 139-143.
5. Mamatha H, Antony Sylvan D’souza, Jessica S, Suhani S. A cadaveric study on the variation in the origin, course and branching pattern of the profunda femoris artery. Int J Cur Res Rev Oct.2012;04(19):137-145.
6. Nachiket Shankar, Roopa R. Unusual bilateral origins of the deep artery of thigh and associated variations. International Journal of Anatomical Variations 2009;2:99-101.
7. Tata Toure, Babou Ba, Abdoulaye Kante, Moumouna Kone, Gaoussou Simpara, Ousmane I. Toure et al. Anatomical study of the external pudendal artery at the anatomy laboratory of Bamako. Eur J Anat,2021; 25 (2): 211-221
8. Hollinshed WH. Text book of human anatomy. Harper and Row 2^nd Oxford and IBH; 1967 .p.443-444.
9. Kundu B, Chakraborty N, Chakraborty S, Alpana De. A cadaveric study on the variation of branching pattern of femoral artery. Indian Journal of Basic and Applied Medical Research; 2017: 6(3):111-117
10. Niri S. Niranjan. Perforator flaps for perineal reconstructions. Seminars in Plastic Surgery 2006;20(2):133-143.