Redefining the fluoroscopic landmarks for common femoral arterial puncture during cardiac catheterization: Femoral angiogram and computed tomography angiogram (FACT) study of common femoral artery anatomy

Abstract

Background The mid‐femoral head (F50) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. Methods We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid‐point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). Results The proximal third of femoral head (F33) (−1.4 mm) and IEA nadir (−2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (−12.8 mm) or cranial end of FH (−15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid‐point of the CFA than F50 (0.3 mm vs. ‐9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non‐CFA punctures (18.6%), while using F50 had a 41.2% risk for non‐CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). Conclusions The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.

Clinical application of Shenton's line to determine the femoral artery bifurcation using the antegrade common femoral artery approach

“…We found that the Shenton's line was located between the central point of the femoral head and the lower margin of the femoral head, where many studies have shown the ideal puncture point. Gopalakrishnan et al [4] found that the junction of the upper three-quarters and the lower one-quarter of the femoral head (F75) was a better puncture point than the traditional mid-point of the femoral head (F50). We found that the Shenton's line is unusually close to the position of F75.…”

Redefining landmarks to improve #safefemoral outcomes

“…The IEA nadir (the lowest take off level) was found to be more than 5 mm below the IEA origin in 71% of patients in the CT angiogram (CTA) cohort while 61% patients in the invasive angiogram cohort revealed similar results. Additional data collected from the CTA cohort demonstrated that F33 (the level of the upper third of the femoral head) and the IEA nadir were closer approximations to the inguinal ligament compared with the origin of the IEA and the cranial end of the femoral head . Most importantly, the nadir of the IEA had the best correlation to the inguinal ligament (R2 = 0.49).…”

“…Gopalakrishnan et al in their recent article have presented a novel technique of assessing femoral access puncture by utilizing the nadir (the lowest take off level) of inferior epigastric artery (IEA) in addition to its relationship with the fluoroscopically visible femoral head (FH) . The authors retrospectively analyzed 114 computed tomography (CT) angiograms and 500 femoral angiograms to ascertain the anatomic relationship of the inguinal ligament to the femoral head and IEA in order to identify the most reliable fluoroscopic landmark for successful proper CFA puncture along with landmarks for defining high punctures.…”

Toward Robotically Automated Femoral Vascular Access

“…In [6], the vessels can be detected visually from the surface of the skin, but as mentioned previously, this only work when vessels are superficial. As the femoral artery extends distally from the inguinal ligament (An area about 4 cm long where vascular access is most feasible) it may vary in its course and depth and may be obscured by 2-8 cms of fat and connective tissue [12]. The combination of varying tissue depth and a range of possible of surgical sites lead us to seek a design (Fig.…”