Anatomical Variant of the Lateral Circumflex Femoral Artery: A Cadaveric Case Report.

The lateral circumflex femoral artery (LCFA), a branch of the deep femoral artery (DFA), supplies the muscular and fascial anatomy of the anterior thigh. An undocumented variation of the LCFA was discovered during a dissection of the lower extremities. The LCFA is a vital vessel that can be used in coronary artery bypass grafts (CABGs) and reconstructive and bypass surgical procedures. On the other hand, the LCFA is susceptible to iatrogenic damage during surgeries involving the hip joint and procedures such as femoral nerve blocks. Knowledge of variations in the origin and course of the LFCA, like many other anatomical structures, is an important concept that physicians and health care providers must be aware of when performing anterior thigh procedures. This case report shows an interesting duplication of the LCFA, the first originating superiorly from the common femoral artery (CFA) and the second from the deep femoral artery (DFA) inferiorly. Both LCFAs exhibited typical trifurcation into ascending, descending, and transverse branches.

Deep Femoral Artery Aneurysm Resection and Revascularization With a Saphenous Vein.

An incidental discovery was made of a right deep femoral artery aneurysm (DFAA) in a plain computed tomography (CT) scan of a 72-year-old male. Although he had been diagnosed with type B aortic dissection six years ago and was followed for 12 months in the outpatient clinic, the patient was no longer receiving regular checkups. After a thorough discussion between cardiovascular surgeons and interventional radiologists, it was decided to proceed with aneurysm resection and revascularization. The postoperative course was uneventful, and the patient was discharged home without complications.

Surgical, endovascular, and hybrid treatment of deep femoral artery aneurysm: Three case reports.

Key Clinical Message: Deep femoral artery aneurysms (DFAA) are extremely rare. We treated four DFAAs with different procedures including surgical, endovascular, and hybrid surgery. The best treatment should be selected for each individual case. Abstract: We report three cases of deep femoral artery aneurysms treated with different techniques. Case 1: A 69-year-old man with a huge deep femoral artery aneurysm underwent open reconstruction using a 6 mm expanded polytetrafluoroethylen graft. Case 2: A 67-year-old man presented with bilateral deep femoral artery aneurysms. The right-sided rupture was treated with hybrid embolization, while the left aneurysm was treated by endovascular stent-grafts deployment. Case 3: A 87-year-old man with a large deep femoral artery aneurysm underwent simply surgical aneurysmectomy. As there are many treatment options for deep femoral artery aneurysms, a comprehensive preoperative assessment is essential, encompassing an evaluation of symptoms, anatomy, and comorbidities.

Retrograde mesenteric perfusion from the deep femoral artery in a patient with a recurrent anastomotic aneurysm in the groin: a case report.

In patients with atherosclerotic disease in two of the three main vessels in the splanchnic circulation, symptoms of chronic mesenteric ischemia may arise, depending on the disease chronicity and the presence of mesenteric collateral pathways. The most commonly described collateral pathways are between the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA); and between the IMA and the internal iliac artery (IIA). Another collateral network between the deep femoral artery and the IIA can also become important, especially in patients with aorto-iliac occlusion. Here we report a patient with a symptomatic anastomotic aneurysm of the right femoral artery after a previous aorto-bi-femoral bypass. This patient's bowel viability relied on a well-developed collateral network from the ipsilateral deep femoral artery. This unusual anatomy required special surgical considerations and planning, to minimize the risk of perioperative mesenteric ischemia. During open repair, distal femoral debranching with a distal-to-proximal anastomotic sequence allowed minimizing of the ischemic time, and avoidance of potential ischemic complications from the visceral circulation. This case emphasizes the importance and benefit of the deep femoral artery and its collaterals as a reserve network of the splanchnic circulation. Favorable outcomes can be achieved with careful analysis of the preoperative imaging and proper planning, with adaptation of the surgical strategy.

Comparison of complete multi-level vs. iliac-only revascularization for concomitant iliac and superficial femoral artery occlusive disease.

Objective: The aim of this study is to compare the efficacy and safety of complete multi-level vs. iliac-only revascularization for the treatment of concomitant iliac and superficial femoral artery (SFA) occlusive disease. Methods: A total of 139 consecutive adult patients with severe stenosis and occlusive iliac and SFA disease with Rutherford categories 2-5 underwent multi-level (n = 71) and iliac-only (n = 68) revascularization at the Department of Intervention Vascular Surgery, Peking University Third Hospital, and Aerospace Center Hospital, between March 2015 and June 2017. Improvement in Rutherford class, perioperative major adverse events, the length of stay, survival rate, and limb salvage rate were assessed. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were compared between the two groups. Results: At 48 months, improvement in the Rutherford category was observed in the two groups with no significant difference (P = 0.809). Additionally, the two groups were similar concerning the primary patency (84.0% vs. 79.1%, P = 0.717) and limb salvage rate (93.1% vs. 91.3%, P = 0.781). A higher proportion of the perioperative major adverse events (33.8% vs. 27.9%, P = 0.455), the all-cause mortality (11.3% vs. 8.8%, P = 0.632), and the average length of hospital stay [7.0 (6.0, 11.0) vs. 7.0 (5.0, 8.0), P = 0.037] were seen in the multi-level group compared with the iliac-only group. Conclusion: For concomitant iliac and superficial femoral artery occlusive disease, iliac-only revascularization has favorable efficacy and safety outcomes compared with complete multi-level revascularization in selected patients with patent profunda femoris artery and at least one healthy outflow tract of the infrapopliteal artery.

Case report: Successful and effective percutaneous closure of a deep femoral artery pseudoaneurysm using proglide device.

A 61-year-old man developed severe swelling in the left lower extremity after interventional embolization of liver tumor. Ultrasound examination showed a pseudoaneurysm and thrombosis in the upper thigh on the left. To recognize the causes and determine the effective therapy, lower extremity arteriography was performed. The results revealed a pseudoaneurysm arised from deep femoral artery. Considering of the size of cavity and symptoms of patient, a new method was tried instead of traditional treatment using PROGLIDE device. Postoperative angiography showed a powerful blocking effect. This case study provide us a specific treatment for pseudoaneurysm, and this method provide us a new therapeutic strategy in clinical practice.

Variations in the bifurcation of deep femoral artery important for electrophysiologist.

Knowing the vascular anatomy of the common femoral artery bifurcation and ultrasound-guided puncture, including doppler, is helpful in recognizing anatomic variations and avoiding complications.

Morphological investigation of deep femoral artery variations using multidetector computed tomography angiography.

PURPOSE: The deep femoral artery (DFA) is the largest and thickest branch of the femoral artery (FA), separated from the posterior lateral surface of the FA. This study aimed to analyze the anatomy of DFA using multidetector computed tomography (MDCT) angiography images to improve its clinical applications. MATERIALS AND METHODS: Eight hundred right and left DFA MDCT angiography images from 400 individuals, 302 males (75.5%) and 98 females (24.5%), were included. RESULTS: It was determined that the DFA originates from six different aspects of the FA. The DFA was found to most commonly originate from the posterolateral aspect of the FA, with an incidence of 53%. The DFA originated from the posterior, lateral, medial, anterolateral, and posteromedial aspects at an incidence of 35.3%, 9.8%, 1%, %0.5, and 0.37%, respectively. The average distance between the DFA's origin and the midpoint of the inguinal ligament (IL) was 43.07 mm across both genders. The average distance between the DFA's origin and the midpoint of the IL was 43.07 mm. The average diameters of the DFA, medial circumflex femoral artery (MCFA), and lateral circumflex femoral artery (LCFA) were 5.62 mm, 3.01 mm, and 3.44 mm, respectively. The average distance between the DFA and MCFA was 14.64 mm, while between the DFA and LCFA, it was 19.05 mm. CONCLUSION: Knowledge regarding the anatomical variants and morphology of the DFA will enhance the accuracy of decision-making during interventional procedures and operations in the femoral region, as well as aid in the prevention of iatrogenic injuries.

Usefulness of perforating branches of the deep femoral artery and vein as recipient vessels during free-flap reconstruction for extensive defects of the thigh.

The perforating branches of the deep femoral artery and vein are considered useful recipient vessels during free-flap reconstruction for extensive defects extending from the knee to the mid-thigh or from the lateral to the posterior region of the thigh. Despite being located deep between the adductor longus and magnus muscles, they can be easily identified, allowing for a sufficient surgical field for the vascular anastomosis. Approximately four perforators from the deep femoral artery can be found on the posterior aspect of the thigh, easily identified by dissecting the semitendinosus and biceps femoris muscles. The calibre and length of the perforators were suitable for vascular anastomosis. In this study, we present three cases of free-flap reconstruction for extensive thigh defects using perforating branches of the deep femoral artery and vein as recipient vessels.

A rare bifurcation of the external iliac artery into femoral and deep femoral arteries.

PURPOSE: The current cadaveric report describes a quite rare unilateral bifurcation of the external iliac artery (EIA) into two femoral arteries (FAs) of almost equal diameter and parallel course, at the level of the inguinal ligament (IL). METHODS: The variant FAs were identified on a 75-year-old formalin-embalmed female cadaver, derived from a body donation program after a signed informed consent. RESULTS: The EIA bifurcated into a FA and a deep femoral artery (DFA). The DFA extremely high origin was identified at the IL level. Both lateral and medial circumflex femoral arteries originated from the DFA. CONCLUSION: The in-depth knowledge of the FA variant origin is of paramount importance to vascular surgeons and interventional radiologists during vessel catheterization and attempts to interpret the angiographic findings. In particular, the DFA's high origin from the EIA and the coexistence of two FAs in a parallel course may pose problems to clinicians during angiographic procedures leading to diagnostic errors. The DFA high origin may also complicate femoral arterial and venous puncture and femoral nerve blocks, due to the close neurovascular relationship. There is a possibility for the FA to be mistaken for a vein leading to accidental intra-arterial injection and consequently thrombosis. Thus, variable arterial pattern is important to be identified preoperatively using Doppler ultrasound imaging.

Femoral artery variation was found during V-A ECMO catheterization.

BACKGROUND: High bifurcation of the deep femoral artery (DFA) is rare in clinical practice, and patients with this variation are less likely to receive venoarterial extracorporeal membrane oxygenation (V-A ECMO) treatment. Therefore, the method by which V-A ECMO is introduced in patients with vascular variation is very important. CASE PRESENTATION: A 52-year-old male patient had ST elevation myocardial infarction due to coronary heart disease. Angiography showed tripartite coronary artery lesions, and coronary artery stenting supported by V-A ECMO was needed. Vascular evaluation before ECMO catheterization revealed high bifurcation of the bilateral DFA located at the inguinal ligament. After discussion, the perfusion cannula was placed in the left superficial femoral artery (SFA) towards the heart, and the distal perfusion catheter (DPC) was placed in the left SFA towards the distal end. Nevertheless, after the patient's heart recovered, necrosis of the toe of the left lower limb still occurred. CONCLUSION: Common femoral artery assessment must be performed before V-A ECMO for patients with high bifurcation of the DFA. Incision catheterization and DPC placement are recommended. After decannulation, arterial repair under direct visualisation is recommended, and rigorous distal vascular assessment and management are needed.

Immunoglobulin G4-related solitary aneurysm of the deep femoral artery.

We have reported the case of an 83-year-old man with a rare immunoglobulin G4 (IgG4)-related solitary deep femoral artery aneurysm. The patient successfully underwent aneurysmectomy and vascular reconstruction with an expanded polytetrafluoroethylene graft. A definitive diagnosis was determined from the comprehensive diagnostic criteria, including histopathologic features of chronic inflammation indicated by massive infiltration of IgG4-positive plasma cells. IgG4-related aneurysmal diseases should be included in the differential diagnosis of deep femoral artery aneurysms, which have traditionally been considered to develop owing to previous trauma or surgery, intervention, infection, and autoimmune or collagen disease.

Pseudoaneurysm and arteriovenous fistula of the deep femoral artery after complete rupture of the vastus medialis muscle: endovascular treatment.

Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.

[Changes in deep femoral artery topography during open revascularization of the lower limbs]. / K voprosu ob izmenenii topografii ust'ya glubokoi arterii bedra pri otkrytykh revaskulyariziruyushchikh vmeshatel'stvakh.

OBJECTIVE: To study topographic changes of femoral triangle arteries during open revascularization of the lower limbs. MATERIAL AND METHODS: A retrospective study included 30 men aged 59.6±3 years with atherosclerotic femoropopliteal occlusion and chronic lower limb ischemia IIb-III stage according to the Pokrovsky-Fontaine classification. All patients underwent open reconstructive interventions. Ten patients underwent above-knee femoropopliteal replacement with a synthetic prosthesis, 10 patients - above-knee femoropopliteal bypass with a synthetic prosthesis, 7 patients - above-knee femoropopliteal bypass with autologous vein, 3 patients - below-knee femoropopliteal bypass with autologous vein. Control group consisted of 30 healthy mean aged 60±2 years. Ultrasound was carried out using the Esaote My Lab Alfa scanner (3-12 MHz linear transducer and 3-5 MHz convex transducer). RESULTS: In healthy volunteers, deep femoral artery always arose from common femoral artery under the angle ≤30° in all cases (20° - 93.3% of cases, 30° - 6.7% of cases). In patients with previous surgical treatment, angle of deep femoral artery varied from 35 to 80°. After femoropopliteal bypass grafting with autologous vein, angle of deep femoral artery varied from 35 to 45° (35° - 8 patients, 40° - 1 patient, 45° - 1 patient). After femoropopliteal bypass grafting with a synthetic prosthesis, angle of deep femoral artery increased up to 40-50° (40° - 2 patients, 50° - 8 patients). In case of previous femoropopliteal replacement with a synthetic prosthesis, angle of deep femoral artery increased up to 70-80° (70° - 7 patients, 75° - 2 patients, 80° - 1 patient). CONCLUSION: Normally, angle of deep femoral artery does not exceed 30°. Open reconstructive surgery on femoropopliteal arteries increases this value from 30° to 80°. Minimal changes are observed after femoropopliteal bypass grafting with autologous vein.

Embolization of Deep Femoral Artery Aneurysm with a Ligated Proximal Artery Using the Direct Percutaneous Puncture Technique.

We report a case of a deep femoral artery aneurysm with a ligated proximal artery that was successfully managed with endovascular therapy. An 84-year-old male was referred to our institute with a history of surgical resection of a left ruptured deep femoral artery aneurysm wherein another aneurysm was found on the peripheral side. Proximal artery ligation of the peripheral lesion was performed. The residual aneurysm had gradually enlarged after surgery, and contrast-enhanced computed tomography showed contrast effects in the aneurysm that extended to the distal artery. The aneurysm was successfully treated by direct percutaneous puncture embolization with N-butyl-cyanoacrylate.

Pseudoaneurisma e fístula arteriovenosa da artéria femoral profunda após rotura completa do músculo vasto medial: tratamento endovascular / Pseudoaneurysm and arteriovenous fistula of the deep femoral artery after complete rupture of the vastus medialis muscle: endovascular treatment

Resumo A artéria femoral profunda, devido às suas características anatômicas, se encontra protegida da maioria dos traumatismos vasculares. Relatamos um caso de pseudoaneurisma de ramo perfurante da artéria femoral profunda, associado à fístula arteriovenosa, secundário a rotura completa do músculo vasto medial em paciente jogador de futebol. A ressonância magnética demonstrou lesão muscular associada a pseudoaneurisma, e a angiotomografia confirmou a presença de pseudoaneurisma associado a fístula arteriovenosa de ramo da artéria femoral profunda. Foi realizado tratamento endovascular da fístula através da embolização com micromolas fibradas e drenagem cirúrgica do hematoma muscular. O paciente evoluiu bem, sem queixas clínicas no 30º dia de pós-operatório e também após 1 ano.

Abstract Due to its anatomical characteristics, the deep femoral artery is protected from most vascular injuries. We report a case of a soccer player with pseudoaneurysm of a perforating branch of the deep femoral artery, associated with an arteriovenous fistula and secondary to complete rupture of the vastus medialis muscle. Magnetic resonance imaging showed muscle damage associated with a pseudoaneurysm and angiotomography confirmed the presence of a pseudoaneurysm associated with a deep arteriovenous fistula of a branch of the deep femoral artery. Endovascular treatment of the fistula was performed by embolization with fibrous microcoils and surgical drainage of the muscle hematoma. The patient recovered well, was free from clinical complaints on the 30th postoperative day and also after 1 year.

A case of deep femoral artery aneurysm found with superficial femoral artery aneurysm.

Objective: Deep femoral artery (DFA) aneurysms are extremely rare cases of aneurysms that are difficult to diagnose. The objective of this report was to discuss the timing and method of surgery for this disease. Patient: We encountered an asymptomatic left DFA aneurysm that was discovered along with a symptomatic aneurysm of the right superficial femoral artery (SFA). Both sides of the aneurysm were resected with Dacron knitted artificial vascular grafts (Gelsoft™ Plus, Vasctek, UK) simultaneously. Result: After the operation, the right SFA had good blood flow, but the graft of the left DFA was occluded. The occlusion was considered to be caused by insufficient blood flow in the graft. The patient was discharged without any complications. Conclusion: The coexistence of DFA aneurysms should be examined if other aneurysms are found. DFA aneurysms are at a high risk of rupture. Careful follow-up is required, and intervention is recommended when the diameter exceeds 35 mm.

Surgical repair of deep femoral artery aneurysm complicated by deep vein thrombosis and pulmonary embolism.

Isolated deep femoral artery aneurysms are rare and tend to be large at the time of diagnosis owing to their deep anatomic location. Deep femoral artery aneurysms are often complicated by rupture, with subsequent lower limb amputation. However, a large aneurysm can compress the surrounding deep femoral vein, leading to thrombosis. In the present report, we have described a rare surgical case of deep femoral artery aneurysm complicated by deep femoral vein thrombosis and pulmonary embolism. Preoperative inferior vena cava filter placement was effective for preventing perioperative worsening of the pulmonary embolism in this particular circumstance.

[Clinical anatomy of deep femoral vessels in the area of femoral triangle]. / Klinicheskaia anatomiia glubokikh sosudov bedra oblasti bedrennogo treugol'nika.

AIM: The purpose of this study was to specify the anatomy of the deep femoral artery and deep femoral vein within the femoral triangle. MATERIAL AND METHODS: The study was based on the data of anatomical dissection of vessels in the area of the upper third of the femur (20 specimens ) and ultrasonographic duplex angioscanning of patients undergoing routine examination of the vascular system (40 patients, 50 lower extremities). Ultrasonography was performed using linear and convex transducers (frequency 3-13 and 3-5 MHz). RESULTS: In the majority of cases, the deep femoral artery originated from the common femoral artery: in 100% of cases in anatomical dissection and in 98% according to the findings of ultrasound duplex angioscanning. Two trunks of the deep femoral artery were revealed in 14% of cases. The findings of ultrasound duplex angioscanning and those of anatomical dissection demonstrated a high origin of the deep femoral artery in 8% and 10% of cases, respectively. In the majority of cases, the deep femoral artery originated from the posterior surface of the common femoral artery: in 46% of cases on ultrasound duplex angioscanning and in 60% of cases in anatomical dissection; along the posterior lateral surface: in 36% according to the data of ultrasound duplex angioscanning and in 40% on dissection. The origin of the deep femoral artery from the medial surface of the common femoral artery was encountered in 8% cases and in 6% of cases was associated with formation of an atypical saphenofemoral junction. One patient was found to have the origin of one of the trunks of the deep femoral artery from the anterior surface of the common femoral artery. Two trunks of the deep femoral vein were revealed in 84% of cases. The proximal trunk flowed into the femoral vein from the lateral surface immediately beneath the ostium of the deep femoral artery, and the distal trunk - 1-1.5 cm lower from the posterior medial side of the femoral vein. CONCLUSION: The knowledge of variant anatomy of deep femoral vessels is very important for decreasing the risk of iatrogenic lesions during surgical manipulations and false-negative results of diagnostic manipulations. If possible, it is always necessary to preoperatively assess variant anatomy of deep femoral vessels (real-time assessment of topography of vessels by means of ultrasound duplex angioscanning, preoperative marking of vessels).

[Advantages of profundoplasty in patients with lower limb critical ischaemia in redo operations]. / Preimushchestva profundoplastiki u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei pri povtornykh operatsiiakh.

Our study was aimed at determining advantages of profundoplasty in patients with critical ischaemia of lower limbs in repeat arterial reconstructions. It included a total of 56 patients subjected to redo operations for thrombosis of a femoropopliteal bypass graft. Of these, 29 underwent profundoplasty (group I) and 27 repeat femoropopliteal bypass grafting (group II). Critical ischaemia was relieved in the early postoperative period in 28 (97%) and 24 (89%) patients of group I and II, respectively. The 3-year patency rate after profundoplasty amounted to 100% and after femoropopliteal bypass grafting to 47% (p<0.05). The lower-limb amputation rates over the 3-year period of follow up amounted to 3 (10%) and 11 (41%), p<0.05, respectively. Over the 3-year period of follow up, there was no statistically significant difference in the values of the ankle-brachial index (p>0.05).