Thefemoral artery is a largeartery in thethigh and the main arterial supply to the thigh and leg. The femoral artery gives off thedeep femoral artery and descends along the anteromedial part of the thigh in thefemoral triangle. It enters and passes through theadductor canal, and becomes thepopliteal artery as it passes through theadductor hiatus in theadductor magnus near the junction of the middle and distal thirds of the thigh.[1]
The femoral arteryproximal to the origin of the deep femoral artery is referred to as thecommon femoral artery, whereas the femoral arterydistal to this origin is referred to as thesuperficial femoral artery.[2]
Thecommon femoral artery (CFA) is located between the inferior margin of theinguinal ligament, and the branching point of thedeep femoral artery. Its first three or four centimetres are enclosed, with thefemoral vein, in thefemoral sheath.[citation needed] In 65% of people, the common femoral artery lies anterior to the femoral vein in the upper thigh.[5] The CFA is, after thepopliteal artery, the most common peripheral site of general dilatation or aneurysmal formation, at a frequency of 1/10 of the aorta.[6] Highly calcific arterial stenosis in the CFA is very difficult to treat by endovascular intervention.[7] Stent positioning in CFA may be limited by compressive or torsional forces, leading to stent fracture and/or restenosis.[7] On the other hand, lithoplasty balloon angioplasty may represent a safe tool to treat CFA stenosis.[7]
Thesuperficial femoral artery[8] is a designation for the segment between the branching point of the deep femoral artery and theadductor hiatus, passing through thesubsartorial canal. However, this term is not listed inTerminologia Anatomica, and usage of the termsuperficial femoral is discouraged by manyphysicians because it leads to confusion among general medical practitioners, at least for thefemoral vein that courses next to the femoral artery.[9] In particular, the adjacent femoral vein is clinically adeep vein, wheredeep vein thrombosis indicatesanticoagulant orthrombolytic therapy, but the adjective"superficial" leads many physicians to falsely believe it is asuperficial vein, which has resulted in patients with femoral thrombosis being denied proper treatment.[10][11][12] Therefore, the segment is alternatively termed thesubsartorial artery.[13] The segment enters theadductor hiatus and becomes thepopliteal artery which goes through thepopliteal fossa.[14]
Therelations of the femoral artery are as follows:
Anteriorly: In the upper part of its course, it is superficial and is covered by skin and fascia. In the lower part of its course, it passes behind thesartorius muscle.
Posteriorly: The artery lies on thepsoas, which separates it from thehip joint, thepectineus, and theadductor longus. The femoral vein intervenes between the artery and the adductor longus.
Medially: It is related to the femoral vein in the upper part of its course.
Thedeep femoral artery is a large and important branch that arises from the lateral side of the femoral artery about 1.5 in. (4 cm) below the inguinal ligament. It passes medially behind the femoral vessels and enters themedial fascial compartment of the thigh. It ends by becoming the fourthperforating artery. At its origin, it gives off themedial andlateral circumflex femoral arteries, and during its course it gives off three perforating arteries.[14]
Superficial femoral artery
Thedescending genicular artery is a small branch that arises from the femoral artery near its termination within the adductor canal. It assists in supplying the knee joint.[citation needed]
The site for optimally palpating thefemoral pulse is in the inner thigh, at themid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine. Presence of afemoral pulse indicates a systolicblood pressure of more than 50 mmHg.[15]
Femoral artery is the frequent site of access inangiography. As the pulsation of the common femoral artery can often bepalpated through the skin; and the site of maximum pulsation is used as a point of puncture forcatheter access.[5] From here, wires and catheters can be directed anywhere in the arterial system for intervention or diagnostics, including the heart, brain, kidneys, arms and legs. The direction of the needle in the femoral artery can be against blood flow (retro-grade), for intervention and diagnostic towards the heart and opposite leg, or with the flow (ante-grade or ipsi-lateral) for diagnostics and intervention on the same leg. Access in either the left or right femoral artery is possible and depends on the type of intervention or diagnostic.[citation needed]
To image the lower limb vascular anatomy, the common femoral artery (CFA) is chosen as the site of entry. However, CFA entry can only be assessed by retrograde puncture. Therefore, a catheter is advanced retrogradely through the contralateral common femoral artery into common iliac artery, crossing the midline into ipsilateral CFA. The SFA can then be assessed by antegrade puncture.[16]
The femoral artery can be used to draw arterial blood when the blood pressure is so low that the radial or brachial arteries cannot be located.
The femoral artery is susceptible toperipheral arterial disease.[17] When it is blocked throughatherosclerosis,percutaneous intervention with access from the opposite femoral may be needed.Endarterectomy, a surgical cut down and removal of the plaque of the femoral artery is also common. If the femoral artery has to beligated surgically to treat apoplitealaneurysm, blood can still reach thepopliteal artery distal to the ligation via thegenicular anastomosis. However, if flow in the femoral artery of a normal leg is suddenly disrupted, blood flow distally is rarely sufficient. The reason for this is the fact that thegenicular anastomosis is only present in a minority of individuals and is always undeveloped when disease in the femoral artery is absent.[18]
^Schulte, Erik; Schumacher, Udo (2006)."Arterial Supply to the Thigh". In Ross, Lawrence M.; Lamperti, Edward D. (eds.).Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. p. 490.ISBN978-3-13-142081-7.
^Thiagarajah R, Venkatanarasimha N, Freeman S (2011). "Use of the term "superficial femoral vein" in ultrasound".J Clin Ultrasound.39 (1):32–34.doi:10.1002/jcu.20747.PMID20957733.S2CID23215861.
