Assessment of the optimal site of femoral artery puncture and angiographic anatomical study of the common femoral artery

Abstract

Objective: The purpose of this study was to evaluate demographic and clinical factors affecting the common femoral artery diameter and length, and anatomical relationship between the femoral head and the common femoral artery during angiography.

Methods: We retrospectively reviewed 109 femoral angiograms. We collected the clinical data of the patients and estimated the common femoral artery diameter and length. We divided the areas in the angiogram from cephalic to caudal direction (zone 0 to 5). The lowest levels of the inferior epigastric artery loop and points of the common femoral artery bifurcation were checked.

Results: The luminal diameter of the common femoral artery was 6.19±1.20 mm. Height, weight, body surface area, as well as common femoral artery diameter were significantly greater in men than in women (p<0.005). The length of the common femoral artery was 27.59±8.87 mm. Height, weight and body surface area showed strong positive relationships with common femoral artery diameter. All of the inferior epigastric artery loops were located above the center of the femoral head. The point of common femoral artery bifurcation was above the center of the femoral head in 4.59% of femoral angiograms.

Conclusions: Males and patients with a high body surface area have a larger common femoral artery diameter. The cumulative probability of optimal targeting between the lowest margin of the inferior epigastric artery loop and the common femoral artery bifurcation is the highest in zone 3 puncture.

Keywords: Angiogram; Common femoral artery; Femoral head.

Fig. 1

Right side biplane femoral angiogram done with anteroposterior (A) and right oblique view (B). Zone of femoral head is divided from 0 to 5 craniocaudal direction. The loop of inferior epigastric artery (arrow) is found at zone 1. The point of common femoral artery bifurcation (arrowhead) is found at zone 5 : common femoral artery (^*).

Fig. 2

A : Anatomy of the inferior epigastric artery in relation to the femoral head. All of the IEA loops are located above the center of the femoral head. The IEA loop is found in zone 0 (n=11, 10.09%), zone 1 (n=67, 61.47%), and zone 2 (n=31, 28.44%). B : Anatomy of the common femoral artery in relation to the femoral head. The point of CFA bifurcation is found in zone 1 (n=2, 1.83%), zone 2 (n=3, 2.75%), zone 3 (n=11, 10.09%), zone 4 (n=40, 36.70%), and zone 5 (n=53, 48.62%). C : The position of the actual puncture site. Actual puncture sites are located in zone 2 (n=9, 8.26%), zone 3 (n=72, 66.06%), and zone 4 (n=28, 25.69%).

Fig. 3

A : The cumulative probability of being above the loop of the inferioir epigastric artery and being below the bifurcation of the common femoral artery can be determined in our study according to the puncture zone. B : Our study shows that if we try to obtain an arterial access with fluoroscopic guidance, while targeting just below the center of the femoral head (zone 3), the cumulative probability of being outside the target zone is the lowest.