Patterns of the circumflex femoral arteries revisited

Abstract

Knowledge of variations of the circumflex femoral arteries is important when undertaking clinical procedures within the femoral region and in hip joint replacement. Since the 19th century, many different patterns have been proposed to classify their origins. This work studied a statistically reliable sample, the lower limbs of 221 embalmed human cadavers (equal right-left and approximately equal sex distributions), and reviewed the previous literature to propose a unified and simple classification that will be useful to clinicians. Statistical comparisons were made using the chi(2) test. The medial and lateral circumflex femoral arteries have been classified into three different patterns based on the levels of their origin. Distribution related to sex and side was also studied. Pattern I: Both arteries arose from the deep femoral artery (346 cases, 78.8%). This pattern was more frequent in females, P = 0.01. There was no significant difference between sides. Type Ia, medial circumflex femoral artery origin was proximal to the lateral circumflex femoral artery origin (53.2%); Type Ib, lateral circumflex femoral artery origin was proximal to medial circumflex femoral artery origin (23.4%); Type Ic, both arteries arose from a common trunk (23.4%). Pattern II: One of the arteries arose from the femoral artery and the other from the deep femoral artery (90 cases, 20.5%). Type IIa, the medial circumflex femoral artery arose from the femoral artery (77.8%) and Type IIb, the lateral circumflex femoral artery arose from the femoral artery (22.2%). There were no significant differences between sexes or sides. Pattern III: Both arteries arose from the femoral artery (2 cases, 0.5%). In every disposition there was a significantly higher prevalence of unilateral rather than bilateral occurrence. In one dissection the medial circumflex femoral artery was absent. Awareness of these variations could avoid unexpected injuries.

Origin of profunda femoris artery and its circumflex femoral branches: anatomical variations and clinical significance

“…The anatomic relationships of MCFA agreed with the data published in the literature [12,21,25] with exception of one case that showed MCFA originating from the medial aspect of SFA and passed superficial to the femoral vein. Similarly, Chitra [5] found 1 case of MCFA originating from FA and coursed in front of the femoral vein.…”

“…Adachi [1] found that LCFA originated from PFA or FA in 78.2% and 13.8% of cases, Siddharth et al [18] in 71% and 16%, Massoud and Fletcher [14] in 81% and 2.8% in their angiographic study, Basar et al [4] in 67.1% and 32.9%, Fukuda et al [9] in 78.2% and 21.4% in their angiographic study, Choi et al [6] in 86.8% and 13.2%, Vasquez et al [25] in 78.8% and 21.2% of cases, Tansatit et al [22] in 56.67% and 43.33% of cases, Uzel et al [24] in 77.3% and 22.7% of cases, Samarawickrama et al [17] in 92.3% from PFA and 8% from common trunk with no from FA, Prakash et al [15] in 81.25% and 18.75% of cases, Dixit et al [8] in 72.8% in right limbs, 77.2% in left limbs and 27.2% in right, 22.8% in left limbs, Anwer et al [2] in 83.33% and 15% of cases, and Sabnis [16] in 80% and 16.6% of cases including the common trunk with PFA. These differences might be in part related to the number of the limbs used in each study or due to an ethnic factor.…”

“…This result was 59.5% found by Lalovic et al [12], 56% on right and 66.7% on left side reported by Dixit et al [8], 62% stated by Samarawickrama et al [17], 63% found by Siddharth et al [18], 63.2% found by Adachi [1], and 67.2% reported by Prakash et al [15]. However, higher percentages were reported by Tanyeli et al [23] in 79%, Massoud and Fletcher [14] in 81%, Vasquez et al [25] in 78.8%, and Anwer et al [2] in 73.33%. Meanwhile, Basar et al [4] in their angiographic study found the normal original pattern of MCFA in 40.9% of the cases.…”

“…The authors added that the knowledge of the original variations of PFA and its circumflex branches is of great significance in preventing the clinical complications that may occur in plastic and reconstructive surgery [8,16,17,25].…”

The descending branch of the lateral circumflex femoral artery as an alternative conduit for coronary artery bypass grafting: Experience from an anatomical, radiological and histological study

“…Radiological studies on the DBLCFA showed that it seems relatively spared from atherosclerosis (Halvorson et al, ). Whereas the branching patterns of the circumflex femoral arteries have been thoroughly mapped by Vazquez et al () and the clinical anatomy of the medial femoral artery has been reported in detail by Clarke and Colborn (), the variability and clinical anatomy of the DBLCFA itself are mostly unknown and only exceptional case studies have been reported (Goel et al, ). Despite being used successfully as the pedicle of anterolateral thigh flaps or fibular grafts in plastic and reconstructive surgery and orthopedics (Choi et al, ; Gokhan et al, ; Jia et al, ), the DBLCFA is still extremely rarely used for CABG.…”