The document provides a detailed overview of femoral artery anatomy, access techniques, and associated complications related to cardiac catheterization. It outlines the anatomical landmarks for locating the common femoral artery, precise puncture techniques, and procedural steps for angiography. Additionally, it discusses the advantages, disadvantages, contraindications, and major complications, including retroperitoneal bleeding and pseudoaneurysm formation.

1. FEMORAL ARTERY
ACCESS

2. ANATOMY
 Femoral artery is the chief
artery of lower limb
 It is the continuation of the
external iliac artery
Origin :
 It enters the thigh from behind
the midinguinal point superficial
to the tendon of psoas major
muscle
 It descends from base to apex of
the femoral triangle and then
enters adductor canal . Finally it
emerges from the adductor
canal by passing through the
hiatus magnus to enter popliteal
fossa

3. Femoral Artery Branches
3 Superficial
branches
3 Deep branches
 Superficial epigastric
artery
 Superficial
circumflex iliac
artery
 Superficial external
pudendal artery
 Profunda femoris
artery
 deeep external
pudendal artery
 Muscular branches

5. How to Access Femoral Artery ?
 Both right and left femoral artery used for
cardiac catheterization
 Right femoral artery is the most commonly used
 The inguinal area is prepared and draped under
sterile conditions

6. Anatomical landmarks to locate common
femoral artery
 Anterior superior iliac spine
 Pubic symphisis
 Inguinal ligament : it is a band of connective
tissue that extends from anterior superior iliac
spine to the pubic tubercle .

7. Palpation of femoral pulse
 It is felt 1/3rd
and 1/2half of the distance from
the medial end of the inguinal ligament
 For right CFA : Place the right thumb on the right
anterior superior iliac spine and the right middle
finger on the pubic symphysis.right index finger
should be located over the femoral artery above
the femoral head
 For left CFA : Place the right thumb on the pubic
symphysis and the middle finger on the left
anterior superior iliac spine . Index finger located
over the femoral artery above the femoral head

9. Where to puncture ?
 The perfect puncture site is the midpoint of
femoral head
 Locate the puncture site is better to locate the
femoral head in ANTEROPOSTERIOR ( AP )VIEW
 Puncture at or above the inguinal ligament
results in retroperitonial bleeding
 Puncture near/lower the femoral head give rise
to pseudoaneurysm formation .

10. STEPS TO PERFORM
 Administration of local anesthesia
 Femoral artery puncture
 Insertion of a 0.018 inch guidewire
 Skin nick (optional)
 Sheath insertion
 Advancement of catheter over a 0.035 inch
guidewire
 Sheath aspiration and flushing
 Femoral angiography

11. Local anesthetic administration
 Load a syringe (usually 10cc of lignocaine)with
local anesthetic
 Insert the syringe needle (usually 26-31 gauge)in
the skin at the intended puncture site
 Aspirate to confirm that the tip of the needle is
not within a vessel
 Administer 10-20 cc of local anesthetic in the
subcutaneous tissue close to the target femoral
artery

12. To Puncture the Femoral Artery
 A single anterior , arterial wall puncture is the
goal
 An 18 gauge needle is inserted at a 45 degree
angle through the skin at the maximal arterial
pulse
 Advance the tip gently through the subcutaneous
tissue, the arterial pulsation is feel at the hub
from the anterior wall of the artery
 Adjust the angulation of the needle depending on
the depth of the artery
 Confirm the entry into the artery by blood flow

14. Wrong puncture
 High puncture : increases the risk of
retroperitoneal hematoma.
Remove the needle ,hold pressure for 1-2mins and
obtain access again.
 Low puncture : increases the risk of
pseudoaneurysm formation.
Remove the needle and obtain the access again at
a higher location

15. Insert 0.08 inch guidewire
 Advance the 0.018 inch guidewire through the
access needle
Skin nick ( optional )
 use a scalpel to make a nick at a guidewire entry
point through the skin
 Do not perform this maneuver with a sheath in
place , since the blade could cut the sheath
causing significant bleeding

16. Insertion of sheath and catheter
over a 0.035 inch guidewire
 Select a sheath for insertion , usually six french
sheaths are usually used for diagnostic
angiography .
 Advance the sheath over the 0.018 inch
guidewire until the hub reaches the skin
 Remove the dilator,and the 0.018 inch guidewire .
 Insert a 0.035 inch guidewire with the cathetrer
through the sheath into the aorta .

17. Sheath aspiration and flushing
 Aspirate the side arm of the sheath and discard
the aspirated blood
 Flush the side arm with a different syringe that
contains heparinized saline

18. Femoral angiography
 Connect the side arm of the femoral sheath with
the manifold
 Confirm the arterial pressure waveform without
dampening
 Perform fluroscopy of the groin area and place
the femoral sheath in the center of the
image .use low magnification to allow
visualization of both iliac vessels and the CFA
bifurction.

19. Continuation
 The most commonly used projection is 20-30
degree RAO for Right CFA (or) LAO for Left CFA to
facilitate visualization of the CFA bifurcation .
 Perform cine angiography ,usually injecting 5-
10ml of contrast .Diluted contrast can be used as
well . The sheath if often pulled medially during
image acquisition , to help identify its entry point
into the femoral artery

20. Femoral artery to coronary
 Common femoral artery
 External iliac artery
 Common iliac artery
 Abdominal aorta
 Thoracic aorta
 Descending aorta
 Arch of aorta
 Ascending aorta
 Coronary ostium

22. Advantages
 Ease catheter and guidewire advancement
 High succesful rate
 Have no recurrent loop,tortuosity
 Have no chances of arterial vasospasm

23. Disadvantages
 Compress the access site with more pressure
 High risk of retroperitoneal bleeding and
pseudoaneurysm formation
 Immobile of the accessment site for 4-6 hrs
 Femoral artery is the only supply to the leg

24. Contraindication
 Severe abdominal aortic aneurysm
 Severe peripheral vascular disease
 Complex aorto-ileo femoral grafts
 Arterio-iliac venous fistula
 Decreased femoral pulse .

25. Post Procedural Complications
Major complications
 RETROPERITONEAL BLEEDING :
 It is a potential life threatening complication of femoral
artery puncture that should be suspected in
postcatheterzation patient who develops
hypotension ,ipsilateral flank,abdominal pain or back
pain ,or drop in a hemoglobin without a source , result
in puncture at or above the inguinal ligament

26. Major complications cont …
 PSEUDOANEURYSM :
 It is acommunication between the femoral artery and
the overlying fibromuscular tissue resulting in a blood
filled cavity . It is formed when blood escapes from the
lumen of an artery through a defect in one or more
layers of the arterial wall and forms a pocket beneath
the adventitia of the artery or in the surrounding tissue
near the site of arterial puncture

27. Major complication cont…
 AV FISTULA :
 It is an abnormal connection between a vein and
artery,asymptomatic,it is result from arterial puncture
below the femoral artery bifurcation ,created between
the superficial or deep feemoral artery and the adjacent
lateral circumflex vein .

28. Others
 Hematoma
 Limb ischemia
 Infection
 Perforation
 Dissection

29. THANK YOU