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Medial circumflex femoral artery

The medial circumflex femoral artery (MCFA) is a key branch of the profunda femoris artery (deep femoral artery), though in some individuals it may arise directly from the femoral artery. It courses medially and posteriorly between the pectineus and iliopsoas muscles, then passes between the obturator externus and adductor brevis to reach the posterior aspect of the hip joint.

The MCFA is the principal arterial supply to the femoral head and neck, via its posterior retinacular branches that ascend beneath the hip joint capsule. It also supplies the adductor muscles and forms anastomoses with the lateral circumflex femoral artery, inferior gluteal artery, and obturator artery, contributing to the cruciate anastomosis of the thigh.

Clinically, the MCFA is of major importance: injury or occlusion (e.g., in femoral neck fractures or hip dislocations) can result in avascular necrosis (AVN) of the femoral head. It is also relevant in orthopedic surgery, trauma management, vascular reconstructions, and interventional radiology.

Synonyms

  • Arteria circumflexa femoris medialis

  • Internal circumflex artery of thigh

  • Femoral head nutrient artery

Function

  • Supplies femoral head and neck, the most critical vascular input

  • Provides branches to the adductor muscles and hip joint capsule

  • Participates in cruciate and trochanteric anastomoses, ensuring collateral flow

  • Key vessel in hip viability, orthopedic surgery, and trauma outcomes

MRI Appearance

T1-weighted images:

  • MCFA appears as a linear hypointense flow void in fat planes medial to hip

  • Posterior retinacular branches sometimes visualized near femoral neck

T2-weighted images:

  • Normal flow: signal void

  • Thrombosis, aneurysm, or slow flow: hyperintense lumen

STIR:

  • Suppresses fat, making the vessel’s course easier to trace in pelvic fat planes

  • Highlights perivascular edema or hemorrhage

T1 Fat-Suppressed Post-Gadolinium:

  • Artery enhances brightly and homogeneously

  • Excellent for detecting course around hip capsule and retinacular branches

  • Useful in identifying vascular compromise or tumor encasement

MRA Pelvis with Gadolinium:

  • Depicts origin from profunda femoris/femoral artery, medial course, and anastomoses

  • Clearly shows retinacular branches to femoral head and neck

  • Essential for pre-surgical hip mapping, AVN assessment, and trauma evaluation

CT Appearance

Non-contrast CT:

  • Artery not well seen; location inferred between iliopsoas, pectineus, and adductor muscles

  • Calcifications may be seen in atherosclerotic cases

CT Post-Contrast:

  • Artery enhances clearly, outlining medial and posterior course

  • Demonstrates relationship to femoral neck, hip capsule, and adductor region

  • Helpful in detecting active bleeding, vascular injuries, or collateralization

CT Angiography (CTA):

  • Gold standard for visualizing MCFA anatomy and variants

  • Multiplanar and 3D reconstructions show origin, retinacular branches, and anastomoses

  • Critical for orthopedic surgeons to assess risk of AVN in femoral head fractures or hip dislocations

  • Detects aneurysms, stenosis, and vascular injury

CT VRT 3D image

medial circumflex femoral artery CT 3D VRT anatomy image

CT image

medial circumflex femoral artery MRI axial anatomy image-img-00000-00000

MRI image

medial circumflex femoral artery MRI axial image MRI axial anatomy image-img-00000-00000