Femoral artery techniques

To monitor arterial blood pressure, a 4 cm incision is made over the right femoral region and the femoral artery is isolated. A trocar is used to pass the blood pressure catheter from the abdomen to the femoral incision. An arterotomy is made in the femoral artery and the catheter introduced 10 cm into the artery and the catheter secured using standard techniques. 

The reference number and the technique are indicated parenthetically in the columns. The techniques are designated as follows a, tail cuff in conscious mice b, carotid artery in awake mice 24 h after surgery with isoflurane c, carotid artery in awake mice 3 h after surgery with halothane d, carotid artery in awake mice 24 h after surgery with pentobarbital e, carotid artery in mice under pentobarbital anesthesia f, telemetry in awake mice 1 wk after surgery with isoflurane g, echo under anesthesia h, echo in conscious mice i, femoral artery telemeter 10 d after ketamine and xylazine anesthesia j, femoral artery in awake mice 3 d after surgery with pentobarbital. 

Arterial puncture requires considerable skiE and is usuaEy performed only by physicians or speciaEy trained technicians or nurses. The preferred sites of arterial puncture are, in order, the (1) radial artery at the wrist, (2) brachial artery in the elbow, and (3) femoral artery in the groin. Because leakage of blood from the femoral artery tends to be greater, especially in the elderly, sites in the arm are most often used. The proper technique for arterial puncture is described in NCCLS Standard Hll-A3. ... 

Streaming-potential and, to a lesser extent, electroosmosis techniques in physiologic fluids (0.154 N NaCl or Krebs solution). Streaming-potential measurements have also been carried out in vivo on protheses fabricated using insulator materials and implanted in canine carotid and femoral arteries. The experimental technique used for this purpose is akin to that described in Section 3.1. 

Technical Considerations Catheterization of the bronchial arteries is best approached from the femoral artery. Since most patients with lung cancer are older and the aorta is tortuous and atherosclerotic, a 5-F catheter with good torque control in a shepherd s crook (reverse curve) or forward seeking configuration is recommended. A finely tapered tip catheter for access which would allow a 3-F microcatheter coaxial system is optimal to bypass the spinal artery. The use of nonionic contrast media should minimize pain and the risk of contrast media-induced complications. The digital subtraction technique is of value for the identification of the anterior spinal artery with small branches to the spinal cord. 

Once it has been ascertained that inflow to the level of the femoral arteries is adequate, infrainguinal reconstruction can be undertaken. The two traditional approaches for correcting arterial occlusion are either to open the artery and remove the obstruction by endarterectomy, or to fashion a bypass around the obstruction. Longstanding experience has established direct bypass of obstruction as the dominant and superior technique. However, endarterectomy is still used as an adjunct to bypass grafting, and even sometimes alone, such as in the case of a profundo-plasty to repair a stenotic profunda femoris artery. 

Conventional Seldinger technique is generally used for the majority of the procedures, and a femoral sheath with hemostatic valve (4 to 9 French) is placed into the femoral artery to allow the exchange of the catheters, reducing the trauma to the artery. 

US and Doppler techniques are accurate means to diagnose injuries to the femoral vessels in the groin. These usually occur as a result of iatrogenic procedures (arterial catheterization), but may also be involved in displaced fractures of the pubis and the femoral neck, crush injuries, blunt trauma and so forth. The most common site for arterial injuries is the common and proximal superficial femoral artery. The main complication is a pseudoaneurysm. Other less frequent complications include thrombosis, arteriovenous fistula, dissection, intimal flaps and perivascular hematoma. Pseudoaneurysms of the femoral artery follow a tear of the vessel wall followed by leakage of blood from the artery into the adjacent tissue and usually appear as pulsatile well-defined anechoic masses located closely to the artery (Fig. 12.41). Mural thrombus is often present and partially fills the pseudoaneurysm sac. Blood flow inside the pseudoaneurysm is typically swirling with alternating red and... 

Extraction using the femoral vein is a much more versatile approach, hi reality, extraction via the femoral vein may be used as a primary approach and is the procedure of choice for extraction of broken or cut leads that are free-floating in the venous system, heart, or pulmonary artery. It is also the technique of choice in situations of grossly contaminated venous entry sites where there is risk of pushing contaminated debris into the central circulation by the superior approach. There are a variety of techniques for extracting leads by the femoral vein approach (Table 6.6). 

Angioplasty for claudication can be separated into two anatomic areas for purposes of applicable techniques and expected results. The suprainguinal region describes stenoses in the aortoiliac vessels, whereas the infrainguinal area of pathology includes the femoral and popliteal arteries as well as vessels below the knee. 

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