[Rational and topographo-anatomical scheme for exposure of the femoral artery and of the femoral vein on various levels].
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Arteries↗
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The use of papaverine in arterial sheaths to prevent loss of femoral artery pulse in pediatric cardiac catheterization.
This study evaluated the efficacy of intraarterial papaverine infusion after pediatric cardiac catheterization in reducing the incidence of lost pulse. This study was conducted at a teaching pediatric hospital and was designed as a randomized, prospective, double-blind, placebo-controlled study. Patients were children 5 years old or less undergoing antegrade and retrograde heart catheterization. The intervention used was an intraarterial infusion of placebo or 1.5 mg/kg papaverine after catheterization. Bilateral femoral artery ultrasound study was performed pre- and postcatheterization, including two-dimensional, color, spectral, and pulsatility index analysis. Outcome measures included clinical loss of pulse, ultrasound findings, plus other clinical factors. Fifty-six patients participated in the study (28 per group). Six patients clinically lost the pulse in the catheterized arteries [four in the papaverine and two in the placebo groups (p > 0.64)]. Clinical loss of pulse correlated with diminished pulsatility index (p < 0.035). The use of papaverine did not prevent decreased pulse or pulsatility index (p > 0.79). Increased arterial time was the only clinical factor associated with lost pulse (p < 0.0004). Pulsatility index <3.34 correlated with loss of pulse in the catheterized artery. The results indicated that intraarterial papaverine infusion after femoral artery catheterization does not prevent loss of pulse in the catheterized artery, and decreased pulsatility index correlates with diminished pulse and represents a good noninvasive method of evaluating femoral artery patency and flow.
Cardiac Catheterization↗
Estimation of femoral arterial blood flow from femoral venous oxygen saturation.
In six patients in whom a femoro-popliteal vein bypass graft was performed for intermittent claudication, the relationship between the haemodynamic state of the leg and the femoral venous oxygen saturation before and after local vasodilatation was investigated. The study was undertaken with special reference to the known influence of hypovolaemia on the leg blood flow. It is concluded that a femoral venous oxygen saturation below 70%indicates that the leg blood flow is less than 200 ml/min and that the bypass flow is less than 100 ml/min and thus within a range in which the incidence of early thrombosis is high. Furthermore, an increase in femoral venous oxygen saturation of 10% or more on local vasodilatation indicates a state of hypovolaemia, necessitating further blood substitution.
Arteriosclerosis Obliterans↗
Contractile and relaxant responses of diabetic dog femoral arteries.
Strips of femoral arteries of normal and alloxan-treated dogs were set up for isometric recording. The contractile response to phenylephrine and the relaxant response to acetylcholine were determined. Neither alloxan treatment nor mechanical removal of endothelium altered the EC50 value for phenylephrine. The slope of phenylephrine dose-response curves of diabetic and healthy vessels with intact endothelium was similar, whereas the slope of phenylephrine dose-response curves of endothelium-denuded diabetic arteries was significantly greater than that of the denuded healthy arteries. Removal of the endothelium completely abolished the relaxant effect of acetylcholine. The relaxant potency (IC50) of acetylcholine was not affected by alloxan treatment. The results suggest that in canine femoral arteries the relaxant activity of acetylcholine is unaffected in experimental diabetes and the damage of the arterial endothelium may play a role in the increased responsiveness of diabetic vessels to adrenergic agonists.
Acetylcholine↗
Adaptation of the left heart, cerebral and femoral arteries, and jugular and femoral veins during short- and long-term head-down tilt and spaceflights.
The objective of this investigation was to identify the major cardiovascular changes induced by exposure to real or simulated Og (spaceflights: 6, 14, 21 and 25 days, and 6 months; head down tilt, HDT: 10 h, 4, 5, 7, 30 and 42 days), with a minimum of counter-measures. The following cardiovascular data were measured by echocardiography and Doppler ultrasonography: left ventricle end-diastolic volume (LVDV), stroke volume (SV), cardiac output (CO), ejection fraction (EF), middle cerebral artery flow velocity (Qca), femoral artery flow velocity (Qfa), cerebral vascular resistance (Rca), femoral vascular resistance (Rfa), jugular vein cross-sectional area (Ajv), femoral vein cross-sectional area (Afv), heart rate (HR), and mean blood pressure (MBP). LVDV remained decreased compared to pre-HDT or pre-flight levels after 1 week of spaceflight or HDT (-8 to -13%, P<0.05), EF did not change. HR tended to increase (5-10%) during spaceflight and HDT, whereas MBP tended to decrease during flight, but did not change in HDT. These findings are consistent with the existence of a moderate and stable hypovolemia. Qca and Rca fluctuated between +10 and -10% from pre-HDT or pre-flight values, and always showed opposing variations. There was no significant decrease in cerebral perfusion. Lower-limb resistance (Rfa) remained decreased (-5% to -18%, P<0.05) throughout the flights or HDT after week 1. Ajv remained significantly enlarged (+40% P < 0.05) after 1 week in spaceflight or in HDT. Afv was enlarged in spaceflight after week 1 (+15% to +35%, P<0.05), whereas it decreased after 4-5 days of HDT (-20% to -35%, P<0.05). The cardiovascular system reached a new and stable equilibrium during flight and HDT within less than 1 week. With the exception of the femoral vein, there was no significant difference in either the amplitude or the time course of the cardiovascular changes in both situations after 1 week.
Adaptation, Physiological↗
Management of femoral artery obstruction. Complications of femoral venipuncture.
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Blood Specimen Collection↗
General case of the day. Traumatic arteriovenous fistula between the right superficial femoral artery and the deep femoral vein with a large external iliac venous aneurysm.
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Aneurysm↗
Ultrasound assessment of atherosclerotic vessel wall changes: reproducibility of intima-media thickness measurements in carotid and femoral arteries.
RATIONALE AND OBJECTIVES: Ultrasonography is widely used in cardiovascular research to quantify early atherosclerotic vessel wall changes. In this article, we examined the short- and long-term reproducibility of this technique in the common carotid artery, carotid bifurcation, common femoral artery, and superficial femoral artery. Furthermore, we assessed the effect of progressed atherosclerosis on reproducibility. METHODS: Repeated ultrasound examinations were performed by one observer on 15 healthy individuals and 18 patients suffering from coronary heart disease. Intima-media thickness was determined by B-mode ultrasonography. The examinations were repeated by the same observer after a short time interval (short-term) and after a few weeks (long-term) and expressed as the mean difference between the measurements and the coefficient of variation (CV). RESULTS: The reproducibility of the intima-media thickness determination turned out to be best in the common carotid artery and the superficial femoral artery when performed in healthy controls (CV 5.6% and 5.5%, respectively). Reproducibility was less in patients with clinical atherosclerosis; this especially affected the reliability of the superficial femoral artery measurement (CV in healthy controls was 5.5%; in coronary heart disease patients, 17.5 %). The reliability of the intima-media thickness measurements in the common carotid artery (CV in healthy controls was 5.6%; in coronary heart disease patients, 9.5%) proved to be least affected by progressed atherosclerosis. A longer time interval between measurements did not affect the reproducibility of intima-media thickness measurements in healthy controls, whereas in the patients it led to some decrease of reproducibility and to a major decrease in reproducibility of the superficial femoral artery measurements (CV changed from 12.7% to 17.5%). CONCLUSIONS: Ultrasonography is a reliable and accurate technique to determine intima-media thickness in superficial arteries. In studies in which the intima-media thickness determination is used as a marker for generalized and coronary atherosclerosis, the common carotid artery should always be included, whereas the benefit of inclusion of other arteries depends on age and the expected extent of atherosclerosis in the individuals studied.
Adult↗
[Percutaneous transluminal angioplasty via dorsalis pedis artery for chronic total occlusion of superficial femoral artery: a case report].
A 60-year-old woman with intermittent claudication underwent angiography, which showed total occlusion of the left superficial femoral artery and no distal flow. Computed tomography with contrast medium revealed that the occlusion extended to the popliteal artery but distal flow was maintained to the dorsalis pedis artery. Percutaneous transluminal angioplasty was attempted via the right femoral artery, but the guidewire could not be advanced. Therefore, a 4F sheath was inserted into the dorsalis pedis artery and the guidewire was passed through the occluded lesion. After pre-dilation, the guidewire was re-crossed from the right femoral artery and two stents were successfully implanted. Finally sufficient antegrade blood flow was achieved after the procedure. The trans-dorsalis pedis artery approach is a valuable option for the percutaneous transluminal angioplasty of long superficial femoral artery occlusion if the antegrade approach is impossible.
Angioplasty, Balloon, Coronary↗
Noninvasive detection of iliac artery stenosis in the presence of superficial femoral artery obstruction.
In patients with superficial femoral artery obstruction, iliac disease may be difficult to diagnose by commonly used noninvasive techniques. We studied common femoral artery acceleration time (onset of systole to peak systole), as measured from a Doppler spectral display and expressed in milliseconds. Previous work has suggested that an acceleration time of 144 msec or greater is abnormal and is associated with iliac stenosis (greater than or equal to 75% diameter reduction) or occlusion. During a 2-year period, in 139 limbs with superficial femoral artery obstruction, acceleration times were measured immediately before angiography. The overall test accuracy was 94.2% (131/139). In the 112 sides with normal angiograms, the acceleration time correctly identified no disease in 109 patients (97.3% specificity), and in the 27 iliac stenoses or occlusions the test detected disease in 22 patients (81.5% sensitivity). This appears to be a good test that can be done with equipment usually available in most vascular laboratories.
Angiography↗
Brachial and femoral artery blood flow in cirrhosis: relationship to kidney dysfunction.
Brachial artery and common femoral artery blood flows and cardiac output were measured with duplex-Doppler ultrasonography in 12 normal subjects, 12 patients with compensated cirrhosis and 35 patients with cirrhosis and ascites (8 with functional kidney failure). The aim of this study was to investigate whether arteriolar vasodilation in these vascular territories contributes to hyperdynamic circulation in cirrhosis. Cardiac output was significantly increased and systemic vascular resistance significantly reduced in the three groups of cirrhotic patients. We found no significant differences between normal subjects and compensated cirrhotic patients in brachial artery (55 +/- 7 vs. 57 +/- 7 ml/min) and femoral artery (353 +/- 20 vs. 310 +/- 25 ml/min) blood flow. Nonazotemic cirrhotic patients with ascites showed significantly lower (p < 0.05) brachial artery blood flow (40 +/- 3 ml/min) than healthy subjects and compensated patients. Femoral artery blood flow (327 +/- 25 ml/min), however, was not significantly different. Brachial artery (25 +/- 3 ml/min) and femoral artery (213 +/- 22 ml/min) blood flows were markedly reduced in the patients with kidney failure (p < 0.05 with respect to the other three groups). Glomerular filtration rate correlated directly with brachial (r = 0.74, p = 0.0001) and femoral (r = 0.52, p = 0.03) artery blood flow in the cirrhotic patients. These results indicate that the arteriolar vasodilation causing hyperdynamic circulation in cirrhosis does not take place in the brachial and femoral vascular territories.
Aged↗
[Deep lesion of the femoral artery and fracture of the femoral diaphysis. Value of selective embolization].
The authors report a case of an osteosynthesized fracture of the femoral shaft with a lesion of the deep femoral artery revealed at a late stage by sudden appearance of a hematoma. A diagnostic arteriogram was performed, followed by therapeutic embolization: temporary hemostasis was achieved by the hyper-selective injection of Gelfoam, thus allowing anti-coagulant therapy for associated venous thrombosis to be continued, without abnormal delay in bone consolidation.
Adult↗
Time course of arteriogenesis following femoral artery occlusion in the rabbit.
OBJECTIVE: We examined the time course of arteriogenesis (collateral artery growth) after femoral artery ligation and the effect of monocyte chemoattractant protein-1 (MCP-1). METHODS: New Zealand White rabbits received MCP-1 or phosphate buffered saline (PBS) for a 1-week period, either directly or 3 weeks after femoral artery ligation (non-ischemic model). A control group was studied with intact femoral arteries and another 1 min after acute femoral artery ligation. RESULTS: Collateral conductance index significantly increased when MCP-1 treatment started directly after femoral artery ligation (acute occlusion: 0.94+/-0.19; without occlusion: 168.56+/-15.99; PBS: 4.10+/-0.48; MCP-1: 33.96+/-1.76 ml/min/100 mmHg). However, delayed onset of treatment 3 weeks after ligation and final study of conductance at 4 weeks showed no significant difference against a 4-week control (PBS: 79.08+/-7.24; MCP-1: 90.03+/-8.73 ml/min/100 mmHg). In these groups increased conductance indices were accompanied by a decrease in the number of visible collateral vessels (from 18 to 36 identifiable vessels at day 7 to about four at 21 days). CONCLUSION: We conclude that the chemokine MCP-1 markedly accelerated collateral artery growth but did not alter its final extent above that reached spontaneously as a function of time. We show thus for the first time that a narrow time window exists for the responsiveness to the arteriogenic actions of MCP-1, a feature that MCP-1 may share with other growth factors. We show furthermore that the spontaneous adaptation by arteriogenesis stops when only about 50% of the vasodilatory reserve of the arterial bed before occlusion are reached. The superiority of few large arterial collaterals in their ability to conduct large amounts of blood flow per unit of pressure as compared to the angiogenic response where large numbers of small vessels are produced with minimal ability to allow mass transport of bulk flow is stressed.
Animals↗
Surgical treatment of noniatrogenic trauma of the femoral arteries.
Trauma to the femoral arteries corresponds to 30 percent of all arterial traumas. The authors reviewed 74 patients with noniatrogenic trauma of the femoral arteries treated from January 1991 to December 1993. Ages ranged from 11 to 50 years, with a mean of 24. Seventy-one patients were male and three female. Fifty-two patients (70.2 percent) were white, 20 (27 percent) were black and two (2.8 percent) were Asian. Trauma due to firearms had the highest incidence, with 61 cases (82.4 percent). Absence of pulse was the most frequent clinical symptom (62.5 percent). Severe ischemia, with risk of loss of limb, was found in 66.2 percent of the cases. The superficial femoral artery was impaired in 77 percent of the cases. A preoperative arteriography was performed on only five patients, victims of multiple penetrating trauma or an asymptomatic penetrating wound along a vessel passage. In six cases, arterial and venous ligature was the chosen procedure. In three cases, a primary arterial anantomosis was performed. Simple arterriorraphy was feasible in one patient. In 64 of the patients, a venous graft was undertaken using a segment of the inverted great saphenous vein withdrawn from the other lower limb. Fasciotomoy was used in 32 patients (43.2 percent), all of whom exhibited pasting of the lower limb muscles at admission. One patient died during the immediate postoperative period as the result of multiple organ failure caused by polytraumatism. Preservation of the limb was attained in 72 patients (97.3 percent) Severe, previously-incurred ischemia was responsible for the only two amputations, aggravated by an exceedingly long delay between the time of injury and surgery. One of these patients, in addition to severe ischemia, had extensive injuries to the soft tissues. We conclude that trauma of the femoral arteries, attended while the limb still maintains its vitality, has a positive clinical outcome with a high rate of limb preservation. Mortality usually results from injury to other organs.
Adolescent↗
The femoral nerve and its relationship to the lateral circumflex femoral artery.
Small branches of the femoral artery in the femoral triangle are not palpable and could increase the risk of intravascular injection during femoral nerve (FN) block. I evaluated the position of the lateral circumflex femoral artery (LCFA), a lateral branch of the femoral artery, in relationship to accepted landmarks for FN blockade, including the inguinal ligament, inguinal crease, and FA. Forty cadaver lower extremities were dissected. In 50% of specimens, the LCFA, as it crossed the FN, was within 1 cm of the inguinal crease, the recommended level for needle insertion for FN blockade. The mean depth of this artery at the inguinal crease was 1.7 cm, whereas the mean depth of the FN was 1.1 cm at this level. In most specimens, the LCFA coursed between the branches of the FN, although it sometimes lay deep to all of the branches. Knowledge of this anatomy may allow for safer FN blockade.
Femoral Artery↗
False aneurysm of the left femoral artery and thrombosis of the left femoral vein after total hip arthroplasty.
We report a 75-year-old male patient with an aneurysm of the left femoral artery after cemented total hip arthroplasty. Two months after the operation, the patient showed a spherical resistance and pain in the left groin. Examination showed a big false aneurysm of the left femoral artery. After resection of the aneurysm, an endovascular stent graft vessel prosthesis was implanted. The aneurysm originated from a punctual lesion of the artery caused by a screw. Since the first description of vessel lesions in orthopaedic surgery in 1964, a total of 24 cases of aneurysm in hip surgery have been described. Therefore, a review of literature tries to explain causes and mechanisms of vessel injuries in hip surgery and the possibilities of repair.
Aged↗
Patterns of the circumflex femoral arteries revisited.
Knowledge of variations of the circumflex femoral arteries is important when undertaking clinical procedures within the femoral region and in hip joint replacement. Since the 19th century, many different patterns have been proposed to classify their origins. This work studied a statistically reliable sample, the lower limbs of 221 embalmed human cadavers (equal right-left and approximately equal sex distributions), and reviewed the previous literature to propose a unified and simple classification that will be useful to clinicians. Statistical comparisons were made using the chi(2) test. The medial and lateral circumflex femoral arteries have been classified into three different patterns based on the levels of their origin. Distribution related to sex and side was also studied. Pattern I: Both arteries arose from the deep femoral artery (346 cases, 78.8%). This pattern was more frequent in females, P = 0.01. There was no significant difference between sides. Type Ia, medial circumflex femoral artery origin was proximal to the lateral circumflex femoral artery origin (53.2%); Type Ib, lateral circumflex femoral artery origin was proximal to medial circumflex femoral artery origin (23.4%); Type Ic, both arteries arose from a common trunk (23.4%). Pattern II: One of the arteries arose from the femoral artery and the other from the deep femoral artery (90 cases, 20.5%). Type IIa, the medial circumflex femoral artery arose from the femoral artery (77.8%) and Type IIb, the lateral circumflex femoral artery arose from the femoral artery (22.2%). There were no significant differences between sexes or sides. Pattern III: Both arteries arose from the femoral artery (2 cases, 0.5%). In every disposition there was a significantly higher prevalence of unilateral rather than bilateral occurrence. In one dissection the medial circumflex femoral artery was absent. Awareness of these variations could avoid unexpected injuries.
Aged↗
Catheter lysis and percutaneous transluminal angioplasty below the knee via the popliteal artery in a patient with femoral artery obstruction: technical note.
Acutely occluded lower leg arteries in a patient with a chronically obstructed superficial femoral artery were successfully treated by catheter lysis and dilatation via the popliteal artery.
Acute Disease↗