Femoral artery
The femoral artery is a major blood vessel of the lower limb that plays a critical role in supplying oxygenated blood to the thigh and leg. It is a continuation of the external iliac artery and serves as an important landmark in clinical practice. Understanding its anatomy and branches is essential for diagnostic and interventional procedures.
Anatomy of the Femoral Artery
Origin
The femoral artery originates as a continuation of the external iliac artery at the level of the inguinal ligament. It enters the thigh by passing beneath the ligament and becomes the main arterial supply to the lower limb.
Course
After passing under the inguinal ligament, the femoral artery travels through the femoral triangle, descending along the anterior and medial aspects of the thigh. It continues through the adductor canal and ultimately passes through the adductor hiatus to become the popliteal artery behind the knee.
Relations
The femoral artery is closely associated with several anatomical structures along its course:
- Anteriorly: Skin, fascia, and sartorius muscle
- Posteriorly: Femoral vein and lymphatic structures
- Medially: Femoral vein
- Lateral: Femoral nerve
Branches
The femoral artery gives rise to multiple branches that supply the thigh and surrounding regions:
- Superficial epigastric artery
- Superficial circumflex iliac artery
- Superficial external pudendal artery
- Deep external pudendal artery
- Profunda femoris artery (deep femoral artery) and its branches, including medial and lateral circumflex femoral arteries
Functional Significance
Blood Supply
The femoral artery is the primary source of arterial blood to the anterior and medial compartments of the thigh. Its branches contribute to the circulation of the hip joint, quadriceps muscles, and surrounding soft tissues. The profunda femoris artery further supplies deep structures of the thigh and participates in collateral circulation around the hip and knee joints.
Clinical Importance
The femoral artery is a vital structure for both clinical assessment and intervention. Its superficial course in the femoral triangle allows for easy palpation of the femoral pulse, which is an important diagnostic tool in vascular examination. Additionally, it serves as a common access site for endovascular procedures such as cardiac catheterization, angiography, and peripheral interventions.
Clinical Examination
Pulsation Palpation
The femoral pulse can be palpated in the femoral triangle, midway between the anterior superior iliac spine and the pubic symphysis. It is a central pulse used to assess peripheral circulation and detect vascular compromise.
Assessment in Vascular Diseases
Evaluation of the femoral artery is essential in various vascular conditions:
- Peripheral arterial disease: Reduced or absent femoral pulse may indicate arterial obstruction or stenosis.
- Aneurysms: Palpable pulsatile masses in the groin may signify femoral artery aneurysm.
- Arteriovenous fistulas: Abnormal connections between the femoral artery and vein can be detected by auscultation or palpation of a thrill.
Imaging and Diagnostic Evaluation
Ultrasonography
Doppler ultrasonography provides a non-invasive method to evaluate blood flow, detect stenosis, occlusions, or aneurysms, and assess vessel diameter.
CT Angiography
Computed tomography angiography offers detailed visualization of the femoral artery, its branches, and surrounding structures. It is useful in planning surgical or endovascular interventions.
MR Angiography
Magnetic resonance angiography allows for non-invasive assessment of vessel patency and anatomy without ionizing radiation, making it suitable for repeated evaluations.
Conventional Angiography
Invasive angiography remains the gold standard for detailed evaluation and simultaneous interventional procedures such as angioplasty or stent placement. It provides real-time visualization of blood flow and arterial pathology.
Clinical Conditions Involving the Femoral Artery
Atherosclerosis and Peripheral Arterial Disease
Atherosclerotic plaque formation can lead to narrowing or occlusion of the femoral artery, resulting in decreased blood flow to the lower limb. Patients may present with claudication, ischemic pain, or non-healing ulcers.
Aneurysm Formation
Femoral artery aneurysms are localized dilatations that can be asymptomatic or present as a pulsatile mass. They carry a risk of thrombosis, embolization, or rupture, requiring timely diagnosis and management.
Traumatic Injury
The femoral artery is vulnerable to trauma due to its superficial course in the groin. Injuries may result from penetrating wounds, fractures, or iatrogenic causes, leading to hemorrhage, hematoma, or ischemia.
Thrombosis and Embolism
Acute thrombotic or embolic occlusion of the femoral artery can cause sudden limb ischemia. Prompt recognition and intervention are critical to prevent tissue loss or limb amputation.
Surgical and Interventional Considerations
Access Site for Procedures
The femoral artery is commonly used as an access point for various diagnostic and therapeutic procedures:
- Cardiac catheterization for coronary angiography and interventions
- Peripheral angiography to evaluate lower limb vasculature
- Endovascular interventions including stenting and thrombolysis
Surgical Repair Techniques
Several surgical methods are employed to treat femoral artery pathology:
- Bypass grafting to restore distal blood flow in cases of obstruction
- Endarterectomy to remove atherosclerotic plaque
- Aneurysm repair with interposition graft or ligation depending on anatomy
Complications of Interventions
Procedures involving the femoral artery carry potential risks, including:
- Hematoma or bleeding at the puncture site
- Pseudoaneurysm formation
- Arterial occlusion or thrombosis
- Infection or vascular injury during surgical repair
Variants and Anatomical Considerations
Common Anatomical Variations
The femoral artery exhibits several anatomical variations that may impact clinical practice:
- Variation in the origin or branching pattern of the profunda femoris artery
- Accessory femoral arteries or duplicated segments
- High or low bifurcation into the superficial and deep branches
Impact on Surgical and Interventional Procedures
Anatomical variations can influence the approach and safety of procedures involving the femoral artery:
- Increased risk of inadvertent arterial injury during catheterization
- Challenges in surgical exposure or graft placement
- Importance of preoperative imaging to identify variations
References
- Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020.
- Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 9th ed. Wolters Kluwer; 2020.
- Rohen JW, Yokochi C, Lutjen-Drecoll E. Color Atlas of Anatomy: A Photographic Study of the Human Body. 8th ed. Wolters Kluwer; 2016.
- Patel NH, Diethrich EB. Vascular Access and Interventions: Principles and Techniques. 2nd ed. Springer; 2018.
- Fisher JD, Fitridge R. Vascular Surgery: Principles and Practice. 2nd ed. CRC Press; 2017.
- Dharmarajan TS, Mureebe L. Femoral Artery Aneurysms: Clinical Presentation and Management. J Vasc Surg. 2013;58(6):1551-1557.
- O’Hara PJ, Hertzer NR. Anatomy and Surgical Approaches of the Femoral Artery. Semin Vasc Surg. 2014;27(3):137-144.
- Rutherford RB. Vascular Surgery. 8th ed. Elsevier; 2019.
