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

• Published in: Catheterization and cardiovascular interventions Vol. 89; no. 7; pp. 1185 - 1192
• Main Authors: Seto, Arnold H., Tyler, Jeffrey, Suh, William M., Harrison, Alexander T., Vera, Jesus A., Zacharias, Soni J., Daly, Timothy S., Sparling, Jeffrey M., Patel, Pranav M., Kern, Morton J., Abu‐Fadel, Mazen
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-06-2017
• Subjects: Anatomic Landmarks; anatomic variants; Angiography; Bifurcations; Body Surface Area; Cannulation; catheterization; Catheterization, Peripheral; Catheters; Chi-Square Distribution; Demographics; Demography; Epigastric Arteries - diagnostic imaging; European Continental Ancestry Group; Female; Femoral artery; Femoral Artery - abnormalities; Femoral Artery - diagnostic imaging; Femur; Fluoroscopy; Hip joint; Humans; Logistic Models; Male; Medical imaging; Middle Aged; Multivariate Analysis; Observer Variation; Odds Ratio; Predictive Value of Tests; Prospective Studies; Punctures; Reproducibility of Results; Sex Factors; Ultrasonography, Interventional; Ultrasound; United States; vascular access; vascular complications; Vascular Malformations - diagnostic imaging; Veins & arteries; anatomic variants; catheterization; vascular complications; angiography; vascular access
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26727

Objective
We 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.
Background
In 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.
Methods
Prospectively 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.
Results
The 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.
Conclusion
Operators 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.