Reliable Landmarks for Common Femoral Artery Cannulation: Femoral Head or Inguinal Skin Crease?

Abstract

Context: Angiography catheterization through the femoral artery (FA) carries risks of vascular complications. The optimal site for puncture is above the common FA bifurcation (CFAB) and below the inferior epigastric artery. Aims: This study aims to assess the relationship of the inguinal skin crease with the position of the femoral head and the CFAB. Settings: From March 2014 to March 2015, this study was conducted in a single center. Materials and Methods: Patients above 18 years were eligible for coronary angiography through the trans-FA. The FA cannulation was carried out using an 18G needle. A contrast medium was injected to visualize the common FA (CFA), the CFAB, and the inferior epigastric artery. A reference point was placed tangent to the inguinal skin crease. Results: There were 185 patients, with a mean age of 61.47 ± 8.95 years, and 53.2% were men. CFAB was inferior to the midline of the femoral head in 94.6% of patients and, in relation to the inguinal skin crease, was inferior, equal, and superior in about one-third of patients; the position of the inguinal skin crease was inferior to the midline of the femoral head in 98.1%. The position of the inferior epigastric artery was superior to the femoral head in all patients. There was no significant difference based on gender or body mass index comparison. Conclusions: Because femoral head fluoroscopy is less commonly used as a landmark for a puncture during FA cannulation, the inguinal skin crease may be an applicable point for CFA puncture.

Keywords

• anatomic landmarks
• angiography
• femoral artery
• femur head
• fluoroscopy