Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial

• DOI: 10.1002/ccd.26727
• Publication Date: 2016-08-27T14:49:28Z
• Authors: Arnold H. Seto; Jeffrey Tyler; William M. Suh; Alexander T. Harr...; Jesus A. Vera; Soni J. Zacharias; Timothy S. Daly; Jeffrey M. Sparling; Pranav M. Patel; Morton J. Kern; Mazen Abu‐Fadel
• Keywords: Male; Observer Variation; Chi-Square Distribution; Body Surface Area; Angiography; Reproducibility of Results; Punctures; Middle Aged; Epigastric Arteries; Femoral Artery; 03 medical and health sciences; Logistic Models; Sex Factors; 0302 clinical medicine; Predictive Value of Tests; Catheterization, Peripheral; Multivariate Analysis; Odds Ratio; Humans; Female; Prospective Studies; Anatomic Landmarks

ObjectiveWe sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations.BackgroundIn the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized.MethodsProspectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations.ResultsThe CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin.ConclusionOperators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.