The rare anastomosis with the piriformis branch that provides the blood
supply to the femoral head may be somehow connected with the absence of the MFCA,
with the main vessel supplying the femoral head. A more distal origin of the
common trunk of the epigastric inferior and obturator arteries than usual,
distal to the inguinal ligament (in that case with no MFCA) can suggest that
the main trunk of the MFCA took the course of the corona mortis during its
development. To visualize that hypothesis, we present the case mentioned above
in comparison to a case in which a high level of division of the MFCA directly
from the femoral artery is located near the pubic bone (Figure 5).
The most common type of division of the
medial and femoral circumflex arteries was the truncus profundocircumflexus
perfectus, which was found in 50/100 patients.
By analyzing the pattern of origin of
the MFCA from the femoral artery or deep femoral artery, we found that the MFCA
originated from the deep femoral artery in 66% of patients and from femoral
artery in 33% of patients, it was not found in 1 case.
The same type of division on both sides was seen in 53% of patients.
We have compared our results with those of other studies. Tanyelli’s
study 11 (100 hips, 50 patients, Turkish population) found the MFCA arising
from the deep femoral artery in 81% of patients and from the deep femoral
artery in 15% of patients; he found a double MFCA (one branch from the femoral
artery and another from the deep femoral artery) in 4% of patients.
In a study by Adachi (1928) 8 in a Japanese population, the MFCA was found to originate from the deep femoral artery
in 67.2% of patients and from the femoral artery in 14% of patients.
Another study by Lippert (1985) 12 showed the MFCA originating from the
deep femoral artery in 58% of patients and the femoral artery in 18% of
patients. In a study conducted by Siddharth (1985) 13, the MFCA originated
from the deep femoral artery in 63% of patients and the femoral artery in 26%
of patients, and the respective values in a study by Massound (1997) 14 were
81% and 6,4% of patients.
In our study of a Polish population, we found the MFCA originating from the
deep femoral artery in 66% of patients (the mean value from other authors is
70%). We found the MFCA originating from the deep femoral artery in 33% of
patients, which is significantly different than values reported previously (the
mean value from different studies is 15%).
The atypical origin of the obturator artery from the external iliac
artery, called corona mortis, was described by Adachi, Lippert and Bergmann
8,12,15. Adachi 8 found differences between European and Japanese
populations (28.2% and 13.2%, respectively), in women 6.1% more often than in men.
Lippert 12 and Bergmann 15 found the corona mortis in 20% to 30% of
In our study, the normal origin of the obturator artery from the internal
iliac artery was observed in 67% of patients (67/100), and an atypical origin (called
corona mortis) was observed in 33% of patients (33/100).
The deep branch of the medial
femoral artery and the piriformis branch of the inferior gluteal artery are the
main arteries supplying the femoral head. Therefore, knowledge of their
topography is very important during surgery of the hip region.16