Duplication of the superficial femoral artery: comprehensive review of imaging literature and insight into embryology

Abstract

An extremely rare case of duplicated superficial femoral artery (SFA) was incidentally observed on computed tomography angiogram (CTA) of the lower limbs for presurgical planning for an osteomyocutaneous fibula flap in a patient with T4a oropharyngeal squamous cell carcinoma (SCC). To our knowledge, this is the sixth reported case in the imaging literature. We performed a comprehensive review of the English literature and discuss the underlying embryological origin underpinning this rare anatomical variant.

Duplication of superficial femoral artery: imaging findings and literature review

“…Lower extremity arterial embryology begins at 6-mm human embryo. The sciatic artery develops from the umbilical artery and provides the major blood supply to the lower limb bud [2,5,8,12].…”

“…During development of femoral artery rete, the main arterial supply of the lower limb is the axial artery. Then, this axial artery, arising from dorsal root of the umbilical artery, is interrupted from the 19-mm embryo [2,6,12]. In the embryologic aspect, there is a possibility that duplicated SFA is the result of non-union of femoral artery rete.…”

“…The ramus communicans superior originated from the axial artery has been proposed to act as the fusion point of the SFA duplication. The failure of formation of the ramus communicans superior results in two independent major superficial femoral artery branches [2].…”

“…The precise knowledge of vascular anatomy and its variations is crucial as the treatment with endovascular techniques has increased. Variations of the femoral artery are rarely reported, especially for the superficial femoral artery (SFA) [1][2][3]. Few cases of the duplicated SFA have been reported with limited combinations of imaging modalities, such as computed tomography angiography (CTA), conventional angiography, ultrasonography (US), or magnetic resonance angiography (MRA) [2,[4][5][6][7].…”

“…Variations of the femoral artery are rarely reported, especially for the superficial femoral artery (SFA) [ 1 – 3 ]. Few cases of the duplicated SFA have been reported with limited combinations of imaging modalities, such as computed tomography angiography (CTA), conventional angiography, ultrasonography (US), or magnetic resonance angiography (MRA) [ 2 , 4 – 7 ]. We report a case of the duplicated SFA, which was diagnosed using both CTA and US, with a brief literature review.…”