Anatomic Landmarks of Fluoroscopy Guided Puncture of the Pulseless Femoral Artery

ABSTRACT

PURPOSE: We wanted to improve puncturing the pulseless femoral artery by evaluating the anatomic landmarks that suggest the course of the femoral artery on fluoroscopy. MATERIALS AND METHODS: We analyzed 37 hemipelvis spot images that were centered on the arterial sheath after puncture of the femoral artery. The inguinal angles were measured between the inguinal line connecting the anterior superior iliac spine and the symphysis pubis, and the line of the arterial sheath. Inguinal ligament ratios were measured as the distance from the symphysis pubis to the arterial sheath to the length of the inguinal ligament on the inguinal line. The femoral head ratios were measured as the distance from the medial margin of the femur head to the arterial sheath to the transverse length of the femur head. RESULTS: The mean inguinal angle was 66.5degree (+/-7.8degree) and the mean inguinal ligament ratio was 0.42 (+/-0.03). The mean femoral head ratio was 0.08 (+/-0.18). In comparing the men and women, there was no significant difference in the inguinal angle and the femoral head ratio, but the inguinal distance ratio was larger in women (men 0.41+/-0.033, women 0.44+/-0.031, p < 0.05). CONCLUSION: The femoral artery generally courses just lateral to the medial margin of the femur head (femoral head ratio 0.08) and the medial 40% of the inguinal ligament (inguinal ligament ratio 0.42). So, consideration of these relations may be helpful for puncturing the pulseless femoral artery.