Common Femoral Artery

Vitamin E was found to offer protection in a model of endothelaemia induced by intravenous administration of H202 and in leg ischaemia produced by ligature of the common femoral artery in rats [169]. 

Patient presents with acute lower extremity ischemia, thrombotic lesion in common femoral artery with femoropopliteal bypass occlusion. 

The right common femoral artery is the most conunon site for arterial access. It is the most familiar and tends to be the most comfortahle for the operator. Usually the entire procedure can he easily performed from a single arterial puncture. The contralateral artery is certainly very easy to approach with a C2 catheter as described above. The ipsilateral artery can be more difficult, particularly if a long, reversed curve catheter is not used. Occasionally the patient s anatomy will require the other femoral artery to be accessed. 

Because of the potential difficulty of accessing the ipsilateral artery, some authors have advocated a bilateral common femoral artery approach [38],... 

Complications that can occur at the common femoral artery puncture site include formation of a hematoma, pseudoaneurysm, or arteriovenous fistula, dissection or thrombosis of the common femoral artery, and infection [53, 56]. Vessel perforation is even more unusual than arterial dissection but may be problematic in that it could either cause occlusion of the uterine artery prior to embolization or can cause bleeding from the perforated vessel which may itself require embolization as treatment (Fig. 10.4.4) [56],... 

Figure 33 Intraoperative photograph of a common femoral artery closed with two bovine pericardial patches the distal patch is sutured to the profunda femoral artery.

Derksen WJ, Verhoeven BA, van de Mortel RH, et al. Risk factors for surgical-site infection following common femoral artery endarterectomy. Vase Endovasc Surg 2009 43 69-75. 

Anatomic Considerations The internal pudendal artery, a terminal branch of the anterior division of the internal iliac artery supplies the external genitalia. With extension to inguinal and iliac lymph nodes, additional supply originates from the obturator branch of the internal iliac artery, the inferior epigastric artery from the external iliac artery and the superficial epigastric artery and the superficial and deep external pudendal branches of the common femoral arteries. 

At times, redistribution of supply can be accomplished by selective occlusion of smaller branches of the common femoral arteries so that the entire neoplasm can be infused from the bilateral anterior divisions of the internal iliac arteries. If this is not possible, only a portion of the tumor can be treated on each occasion. Another alternative is the injection of a bolus of the chemotherapeutic agent or combination of agents into each vessel dividing the total dose according to the estimated percentage of supply. 

Fig. 25.5. Lower-extremity CTA in a 84-year-old woman with biiateral calf claudication, left greater than right. MIP shows significant caicifications in the right common femoral artery ([CPA] arrow) and in the proximai SPA arrowhead), as well as in the biiaterai distai SPA/popliteai arteries, respectively. Note, that the calcifications do not allow evaluation for the presence/ degree of arteriai stenoses. MpCPRs in anteroposterior and right anterior obiique views cieariy demonstrate the extent of...

The waveform pattern obtain by duplex scanning can also be used for diagnosing proximal or distal disease (/6,77). A triphasic waveform in the common femoral artery indicates that the ipsUateral proximal vessels are normal. A biphasic waveform would indicate stenosis that is not significant, and a monophasic waveform would signify the presence of significant stenosis or occlusion (Fig. 3). A low-end diastolic velocity indicates a tight stenosis or occlusion distal to the measurement (Fig. 4). 

Fig. 3. Prediction of iliac stenosis from the common femoral artery (CFA) waveform. (A) triphasic waveform in the CFA indicates normal ipsilateral iliac arteries. (B) Diphasic waveform indicates mild to moderate continued on page 32)...

In the setting of hemodynamic instability and undetectable extravasation from the pelvis on angiography, further investigation of other vessels including the lumbar branches, branches of the common femoral artery, superficial femoral artery, and profunda femoral artery should be performed. If there is potential for splenic, hepatic, or renal injury, these vessels should also be evaluated. If all other potential arterial sources have been excluded and the patient remains hemodynamically unstable, then empiric embolization of the internal iliac arteries may be performed. 

After removal of the common femoral artery vascular sheath and proper hemostasis is achieved, the patient is placed on monitoring for 4-5 h and patient controlled analgesia (PCA) pump and i.v. hydration are initiated. At the end of the monitoring period and if no untoward events are noted the patient is sent to the floor. Routine nursing checks and care are adequate thereafter. P.R.N. medication should include (in addition to the morphine or fentanyl PCA pump), anti-nausea and additional pain medication for breakthrough pain. Hydration is critical not only because of the patient s NPO status prior to the procedure and possible nausea, but more importantly to mitigate the consequences of a possible tumor... 

Step 2-Maintaining access. A 5 Fr short vascular sheath providing access in the right or left (strongest pulse) common femoral artery is used at our institution. A 4 Fr access set can be used in cases where less traumatic arterial access is needed (i.e. slightly abnormal coagulation profile), however the smaller catheters may be a bit less controllable. 

Access site complications are unusual as a large-diameter common femoral artery access is rarely required for the embolization. Iatrogenic arterial dissection occasionally occurs at the celiac artery origin during difficult catheterization. In patients with borderline hepatic or renal function, the risk of contrast induced nephropathy and hepatorenal syndrome can usually be prevented with optimal hydration and by limiting the volume ofliver embo-lized. 

Fig. 12.14a,b. Iliopsoas muscle and tendon, a Transverse and b sagittal 12-5 MHz US images obtained over the anterior aspect of the hip joint in a healthy subject demonstrate the iliopsoas muscle (IPs) and tendon (arrow), which are located between the rectus femoris (RF) and the neurovascular bundle, superficial to the anterior capsular plane (white arrowhead) and the articular cartilage (rhombi) of the femoral head (FH). FN, femoral nerve FA, common femoral artery Ac, acetabulum. The photograph and the schematic drawing at the left side of the figure indicate probe positioning... 

Fig. 12.17. Intrapelvic portion of the iliopsoas muscle. Transverse 12-5 MHz US image obtained over the intrapelvic portion of the iliopsoas (IPs) muscle in a healthy subject. The muscle is seen lying over the anterior surface of the iliac bone. Its tendon (arrow) is located in an anterior and medial position. It appears as a well-defined oval hyperechoic structure embedded within the hypoechoic muscle belly. The femoral nerve (FN) is found in a superficial location, just laterally to the common femoral artery (FA). FV, femoral vein. The photograph and the schematic drawing at the left side of the figure indicate probe positioning...

---