Assessment of Femoral Artery Bifurcation Level with Conventional Angiography

Abstract

IntroductionThe common femoral artery (CFA) is the optimal access point for femoral arterial puncture. A higher or lower puncture can result in various vascular complications and by the proper definition of the femoral arterial bifurcation level and the optimal puncture point such complications can potentially be avoided. In the literature, little data is available about the frequency of femoral artery bifurcation and the relationship between the bifurcation level of one artery and its contralateral counterpart in our part of the world.MethodsWe performed a prospective study from April 2016 to September 2016 to define the frequency of bifurcation of the CFA in relation to the femoral head and the relationship between bilateral CFA bifurcations, with bilateral femoral angiography on 579 patients undergoing routine coronary angiography.ResultsThe frequency of normal/low, high, and very high femoral bifurcations was 66%, 26%, and 8%, respectively. There was no significant difference in the bifurcation of CFA between the two sides (p = 0.51). A specific bifurcation level on one side significantly increased the likelihood of the same bifurcation level on the contralateral side (odds ratio (OR) = 151.86 (51.39-448.77)). A multivariable logistic regression analysis revealed age, race, gender, height and weight, body surface area (BSA), and body mass index (BMI) were not predictive of any specific bifurcation level on either side.ConclusionsThe majority (two-thirds) of the individuals in the study population were with normal/low femoral bifurcation with no significant difference in bifurcation level on either side.

VIABAHN® Stent Graft Implantation for Iatrogenic Arteriovenous Fistula and Pseudoaneurysm of the Deep Femoral Artery

“…The frequency of high femoral artery bifurcation has previously been reported as 8% [1]. Additionally, pseudoaneurysms were found in 2.9% of patients and AV fistula in 2.2% of patients after cardiac catheterization [2].…”

High Deep Femoral Artery Bifurcation Can Disturb Safe Femoral Venous Access: CT Assessment in Patients Who Underwent Femoral Venous Access Under Doppler Ultrasound Guidance

“…Unilateral double femoral venous access was performed by one of the radiology residents, fellows, radiologists, or interventional radiologists, using a previously suggested protocol [21]. The presence or absence of arteries in front of the femoral vein, such as the low inferior epigastric artery loop and high DFA bifurcation on contrast-enhanced CT, was evaluated before the procedure [7,22]. Furthermore, immediately before venous access, Doppler ultrasound examination was performed to check the arteries.…”

“…During femoral venous access using Doppler ultrasound guidance, cases with deep femoral artery (DFA) variations that obstruct venous access are often encountered. Some reports evaluated variations in the DFA using angiography or cadavers to determine the impact of arterial puncture or surgery [7][8][9][10][11][12][13]. Others have assessed the variations in the medial and lateral circumflex femoral arteries (MCFA and LCFA, respectively), branches of the DFA, for orthopedic surgery [14][15][16][17].…”

A Guide to Femoral Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta

“…In such cases, the cutdown method described below can be used in combination to reduce the distance from the echo probe to the artery, making identification of the artery on the echo easier [4]. The SFA may be the most palpable if the bifurcation of the CFA is high-level [32,33]. If the puncture position is determined only by the inguinal skin crease or palpation, the position may be inappropriate (often too low).…”

“…The risk of performing a high-level puncture is intra-abdominal puncture or peritoneal or retroperitoneal hematoma [24,[29][30][31][32][33][34]. On the other hand, a lowlevel puncture may result in SFA puncture, guidewire migration to the DFA via the SFA, and arteriovenous puncture [24,[29][30][31].…”