Redefining the fluoroscopic landmarks for common femoral arterial puncture during cardiac catheterization: Femoral angiogram and computed tomography angiogram (FACT) study of common femoral artery anatomy.

BACKGROUND: The mid-femoral head (F50 ) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. METHODS: We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid-point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). RESULTS: The proximal third of femoral head (F33 ) (-1.4 mm) and IEA nadir (-2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (-12.8 mm) or cranial end of FH (-15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid-point of the CFA than F50 (0.3 mm vs. -9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non-CFA punctures (18.6%), while using F50 had a 41.2% risk for non-CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). CONCLUSIONS: The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.