title: Anatomy of the Hunter's canal and its role in the venous outlet syndrome of the lower limb.
abstract: BACKGROUND
  The "Adductor canal syndrome" has been described as an unusual cause of acute arterial occlusion inside the Hunter's canal in young sportsmen. It may also produce a compressive neuropathy of the saphenous nerve. To our knowledge, femoral vein compression in the canal has never been reported.
  
  
  OBJECTIVE
  To describe the anatomy, to propose a physiology of this canal, and to show that the femoral vein is much more exposed than the artery to compression inside this adductor hiatus, particularly at the outlet.
  
  
  METHODS
  The whole adductor canal was exposed in 100 limbs for anatomical study following latex injection. A series of 200 phlebographies and 100 CT venograms were also analyzed.
  
  
  RESULTS
  Anatomically, we found a musculotendinous band called the "vastoadductor membrane," which jointed the adductor tendon to the vastus medialis in all the cases. The femoral vein, located more posteriorly, was frequently narrowed at this level. This band can create a notch with a venous stenosis at the outlet of the Hunter's canal, usually located 12-14 cm above the femoral condyle. Two femoral valves constitute the landmark of the canal on the venograms: the lower is just below the outlet, 9 cm above the condyle. The second valve is 3 cm higher inside the canal.Functionally, the cadaveric simulations showed that the contraction of the adductor longus closes the hiatus, while the adductor magnus opens it. Our hypothesis is that Hunter's canal prevents femoropopliteal axis reflux by synchronizing with calf pump ejection during ambulation.
  
  
  CONCLUSIONS
  Compression of the femoral vein inside the adductor's canal is an underestimated and misdiagnosed cause of postural stenosis of the femoral vein. Ultrasound investigation of both limbs in patients with chronic venous disease (CVD) should be systematically carried out at this precise level in order to prevent future occlusion and onset of acute deep vein thrombosis.
authors.affiliation: URDIA Anatomy Research Unit EA4465, Descartes University, Sorbonne-Paris-Cité, Paris, France jeanfrancois.uhl@gmail.com.
authors.forename: J F
authors.initials: JF
authors.lastname: Uhl
authors.affiliation: URDIA Anatomy Research Unit EA4465, Descartes University, Sorbonne-Paris-Cité, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Gillot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000503:physiopathology*; D002102:Cadaver; D002908:Chronic Disease; D005268:Femoral Vein / Q000473:pathology; D005269:Femur / Q000098:blood supply; D006801:Humans; D007840:Latex; D035002:Lower Extremity / Q000033:anatomy & histology / Q000098:blood supply* / Q000294:innervation; D018482:Muscle, Skeletal / Q000503:physiopathology; D009422:Nervous System Diseases / Q000503:physiopathology; D010690:Phlebography; D012307:Risk Factors; D013848:Thigh / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D020196:Trauma, Nervous System / Q000503:physiopathology; D020246:Venous Thrombosis / Q000503:physiopathology
chemical_list: D007840:Latex
keywords: Hunter’s canal; Venous; adductor canal; anatomy; deep vein thrombosis (DVT) prevention; femoral vein obstruction