Location of femoral artery access and correlation with vascular complications

Optimal femoral artery catheterization plays a very crucial role in minimizing morbidity and mortality associated with cardiac catheterization. Despite religious use of fluoroscopy and anatomical landmarks, suboptimal access occurs in 10–15% of cases. Besides anatomical variations, suboptimal access can be attributed to body habitus (obese versus undernourished), previous scarring, hypoperfused state. Anatomical landmarks (inguinal crease, inguinal ligament, strongest femoral pulse) have high variability, and hence are unreliable [1]. Recently, Seto et al. demonstrated the use of ultrasound in instances where common femoral artery has a high bifurcation [2]. Ultrasound by reducing the attempts to catheterize the artery minimizes the vascular complications. However, there is no difference between fluoroscopy and ultrasound in patients with normal femoral anatomy, making it a less desirable tool in everyday practice. Another technique, which is underutilized, is the use of micropuncture needle for femoral catheterization. In our experience, despite the anatomical variations and suboptimal access, routine use of micropuncture needle reduces vascular complications. Daggubati et al. showed favorable results using micropuncture techniques for femoral artery catheterization by reducing bleeding and transfusion requirements [3]. With frequent use of larger sheaths for complex interventional procedures, fluoroscopically guided micropuncture technique can be a valuable and safe technique [4].