Safe zone for the superficial femoral artery demonstrated on computed tomography angiography

Narulla, Rajpal; Kanawati, Andrew

doi:10.1016/j.injury.2015.12.012

Cited by 17 publications

(19 citation statements)

References 19 publications

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“…Cadaveric studies with 24 and 28 thighs described the level of AH to be above 10 cm (range 8.0-13.5 cm) and 7.4 cm (range 5.6-9.2 cm) from the AT, respectively [21,22]. Kanawati et al assessed 41 limbs using CTA to describe the relationship between the SFA and the whole femoral shaft and warned of the "danger zone" from 239.6 mm to 172.5 mm proximal to the AT [9]. In the current study, the d-V (57.01 ± 11.14 mm) was shorter than the distance between AT and AH described in the literature [21,22].…”

Section: Resultsmentioning

confidence: 99%

“…Kanawati et al proposed doubled width of the femoral condyles as an estimated safe distance proximal to the AT for intervention [9]. They also mentioned the danger zone where SFA crossed inferiorly by halving the distance between GT and AT.…”

Section: Resultsmentioning

confidence: 99%

“…Several methods of evaluating the location of femur artery have been utilised including cadaveric dissection [7,22,23], ultrasonography, angiography [14,24], CTA [6,9,10,17,18,25], and MRI [26][27][28]. We believed MRI provided more valuable information about relationships between soft tissues, including neurovascular bundle, muscles, and fatty tissues.…”

Section: Strengthsmentioning

confidence: 99%

“…BMI was calculated as weight in kilograms (kg) divided by height in meters (m) squared (kg/m 2 ). The femoral length and width, de ned as the distance from the tip of the greater trochanter (GT) to the AT, and the widest portion of the distal femur, respectively [9], were reviewed on lower limb scanograms.…”

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confidence: 99%

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Distances between popliteal vessels to the femur and anthropometric impacts on distal femoral fracture surgery outcome: a retrospective study

Chang

Lin

Chen

et al. 2020

Preprint

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Background:The proximity of the popliteal vessels in the distal femur may increase the risk of iatrogenic vascular injury during cerclage wiring. In this study, the closest location and distance of the popliteal vessels to the femur was examined using magnetic resonance imaging (MRI). The associations between anthropometric factors and the distance that would guide the placement of wires safely during surgery were also identified.Methods:We reviewed knee MRIs of 206 adults and recorded 1) the relation as well as the shortest horizontal distance (d-H) from the femoral cortex to the popliteal vessels in axial images and 2) the vertical distance (d-V) from the adductor tubercle to the axial level of d-H in coronal images. The effects of anthropometric factors (i.e., gender, age, body height, body weight, body mass index, thigh circumference, femoral length, and femoral width) on these distances were analysed.Results:The closet locations of popliteal vessels were at the posteromedial aspect of the femur. The d-H and d-V were 7.38 ± 3.22 mm, and 57.01 ± 11.14 mm, respectively, and were both shorter in women than in men (P < 0.001). Multivariate analysis identified thigh circumference and femoral length as the most influential factors for the d-H and d-V, respectively (P < 0.001). Linear regression demonstrated a strong positive linear correlation between the thigh circumference and the d-H and between the femoral length and the d-V (Pearson’s r = 0.891 and 0.806, respectively [P < 0.001]).Conclusions:The closet location and distance of the popliteal vessels to the femur provide useful information for wire placement during distal femoral fracture surgery while minimising the risk of vascular injury. Given that patients with smaller thigh circumference and shorter femoral length are more likely to have smaller d-H and shorter d-V, respectively, cautious measures should be taken in such cases.Trial registration:retrospectively registered

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Strengthsmentioning

confidence: 99%

mentioning

confidence: 99%

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Distances between popliteal vessels to the femur and anthropometric impacts on distal femoral fracture surgery outcome: a retrospective study

Chang

Lin

Chen

et al. 2020

Preprint

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“…9 From the cadaveric and live human participants, Narulla RS et al demonstrated large safe zone for the superficial femoral artery on computed tomography angiography at around 172.5 ± 40.9 mm proximal to the adductor tubercle. 10 In this case, the surgeon used lateral decubitus position which may cause the thigh in slightly adducted position, while the patient is quite thin with less muscle belly around femur, resulting in an increased risk for femoral artery injury. The L-size cerclage passer may be too large for the small, elderly Asian patient, and it may cause vascular entrapment during cerclage wiring.…”

Section: Discussionmentioning

confidence: 97%

Femoral artery entrapment after cerclage wiring of distal femoral shaft fracture: A case report

Gunadham¹,

Kongkreangkrai²

2019

Journal of Orthopaedics, Trauma and Rehabilitation

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Femoral artery injury after femoral fracture fixation is a rare complication. Previous literature studies focused mostly on proximal femur fracture. We described a case of superficial femoral artery entrapment after internal fixation augmented with cerclage wire. An 80-year-old female underwent fixation with distal femur locking compression plate augmented with cerclage wire. Six hours after the operation, she developed pulseless limb and computed tomography angiogram showed femoral artery entrapped by cerclage wire. After vascular exploration and cerclage wire removal, the femoral artery returned to normal flow without further complication. We review available literature studies on vascular injury after cerclage wiring especially in the distal part of the femur, the so-called safe zone, for the great care needed before cerclage wiring and the importance of immediate diagnosis and treatment.

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The relationship between the femoral artery and vastus medialis muscle coverage at the adductor hiatus during medial closed wedge distal femoral osteotomy in valgus knees

Kawashima,

Takagi,

Kanzaki

2024

J. exp. orthop.

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PurposeThe purpose of this study was to examine the location where the femoral artery contacts the vastus medialis at the adductor tendon hiatus, which is important when using the subvastus approach in medial closed wedge distal femoral osteotomy. We evaluated the correlation between differences in height, vastus medialis morphology, and lower limb alignment.MethodsSixty knees (16 male, 44 female) that underwent plain computer tomography (CT) were included. Using the radiographic hip‐knee‐ankle (HKA) angle as a reference, the knees were divided into three groups of 20 knees: valgus, varus, and neutral. The mechanical lateral distal femoral angle (mLDFA) and distance from the medial femoral epicondyle to the centre of the femoral head (D1) were measured on full‐length weight‐bearing anteroposterior radiographs. The first cross‐section on CT where the vastus medialis muscle and femoral artery connect was defined as the cross‐sectional image for measurement. The direct distance from the medial epicondyle to the measured cross‐sectional image (D2) was measured in the coronal view. The ratio of the vastus medialis muscle width to the femoral posterior wall width was defined as the vastus medialis muscle coverage ratio (CR). Correlations between each measurement and group were evaluated.ResultsThere was a positive correlation between D1 and D2 in the overall, neutral, and varus groups; however, there was no correlation in the valgus group. A positive correlation was observed in terms of the relationship between CR and D2 in the overall and valgus groups. In addition, there was no statistically significant difference in the correlation between the mLDFA and D2, with patient height as a control variable overall and in all groups.ConclusionIn the valgus group, distance to the adductor hiatus was correlated with vastus medialis coverage. Overhang of the vastus medialis may be an important influencing factor of femoral and popliteus artery position.Level of EvidenceLevel III, retrospective cohort study.

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Safe zone for the superficial femoral artery demonstrated on computed tomography angiography

Cited by 17 publications

References 19 publications

Distances between popliteal vessels to the femur and anthropometric impacts on distal femoral fracture surgery outcome: a retrospective study

Distances between popliteal vessels to the femur and anthropometric impacts on distal femoral fracture surgery outcome: a retrospective study

Femoral artery entrapment after cerclage wiring of distal femoral shaft fracture: A case report

The relationship between the femoral artery and vastus medialis muscle coverage at the adductor hiatus during medial closed wedge distal femoral osteotomy in valgus knees

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