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Knowledge of the anatomy of the common femoral artery (CFA) and common femoral vein (CFV) is important to minimize complications associated with transfemoral angiographic procedures. The authors assessed variations in the relationship between the CFA and the adjacent CFV by reviewing the inguinal region of 100 computed tomographic scans of the pelvis (200 vessel pairs). In 65% of the vessel pairs studied, a portion of the CFA overlapped the CFV in an anteroposterior plane. In addition, more than 25% of the artery overlapped the vein in 8% of the vessel pairs. This variation in anatomic relationship between the CFA and CFV is clinically significant, since a femoral vein puncture can be associated with simultaneous passage of the entry needle through the artery and thus formation of an arteriovenous fistula.

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We describe a technique to aid in technically difficult transjugular intrahepatic portosystemic shunt (TIPS) procedures by sonographically guided transabdominal fine-needle portal vein puncture for placement of a 0.018-inch platinum-tipped target guidewire within an appropriate portal venous branch.