The femoral artery is a large
artery in the
thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the
deep femoral artery and descends along the anteromedial part of the thigh in the
femoral triangle. It enters and passes through the
adductor canal, and becomes the
popliteal artery as it passes through the
adductor hiatus in the
adductor magnus near the junction of the middle and distal thirds of the thigh.[1]
The femoral artery
proximal to the origin of the deep femoral artery is referred to as the common femoral artery, whereas the femoral artery
distal to this origin is referred to as the superficial femoral artery.[2]
The common femoral artery (CFA) is located between the inferior margin of the
inguinal ligament, and the branching point of the
deep femoral artery. Its first three or four centimetres are enclosed, with the
femoral vein, in the
femoral 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 the
popliteal 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]
The superficial femoral artery[8] is a designation for the segment between the branching point of the deep femoral artery and the
adductor hiatus, passing through the
subsartorial canal. However, this term is not listed in Terminologia Anatomica, and usage of the term superficial femoral is discouraged by many
physicians because it leads to confusion among general medical practitioners, at least for the
femoral vein that courses next to the femoral artery.[9] In particular, the adjacent femoral vein is clinically a
deep vein, where
deep vein thrombosis indicates
anticoagulant or
thrombolytic therapy, but the adjective "superficial" leads many physicians to falsely believe it is a
superficial vein, which has resulted in patients with femoral thrombosis being denied proper treatment.[10][11][12] Therefore, the segment is alternatively termed the subsartorial artery.[13] The segment enters the
adductor hiatus and becomes the
popliteal artery which goes through the
popliteal fossa.[14]
Relations
The relations 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 the
sartorius muscle.
Posteriorly: The artery lies on the
psoas, which separates it from the
hip joint, the
pectineus, and the
adductor 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.
The deep 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 the
medial fascial compartment of the thigh. It ends by becoming the fourth
perforating artery. At its origin, it gives off the
medial and
lateral circumflex femoral arteries, and during its course it gives off three perforating arteries.[14]
Superficial femoral artery
The descending 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]
Clinical significance
Clinical examination
The site for optimally palpating the femoral pulse is in the inner thigh, at the
mid-inguinal point, halfway between the pubic symphysis and anterior superior iliac spine. Presence of a femoral pulse indicates a systolic
blood pressure of more than 50 mmHg.[15]
Vascular access
Femoral artery is the frequent site of access in
angiography. As the pulsation of the common femoral artery can often be
palpated through the skin; and the site of maximum pulsation is used as a point of puncture for
catheter 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.
Peripheral arterial disease
The femoral artery is susceptible to
peripheral arterial disease.[17] When it is blocked through
atherosclerosis,
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 be
ligated surgically to treat a
poplitealaneurysm, blood can still reach the
popliteal artery distal to the ligation via the
genicular 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 the
genicular anastomosis is only present in a minority of individuals and is always undeveloped when disease in the femoral artery is absent.[18]
See also
Brachial artery, an arm based artery with a similar function
^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.