Femoral Artery Access Using the US-Determined Inguinal Ligament and Femoral Head as Reliable Landmarks: Prospective Study of Usefulness and Safety

Abstract Purpose To evaluate ultrasound (US)-guided femoral artery access using the US-determined inguinal ligament (IL; US-IL) and femoral head as anatomic landmarks to prevent "high stick" (ie, cannulation above the IL) of the common femoral artery (CFA). Materials and Methods Fifty consecutive US-guided femoral artery accesses for embolization of hepatocellular carcinoma (n = 49) or renal angiography (n = 1) between December 2008 and August 2009 were prospectively analyzed. Primary endpoints were evaluation of technical success and major/minor complications during the procedure and follow-up visits. Secondary endpoints were the relative locations of the US-IL, fluoroscopically determined IL (FL-IL), and origin site of the inferior epigastric artery (IEA) on completion angiography. Relationships were evaluated between CFA types and lengths on US, between CFA types on US, and between frequencies of low-lying US-IL on fluoroscopy. Spearman correlation, Student t test, and Fisher exact test were used for statistical analysis. Results Technical success of CFA access was achieved in all patients (100%), with no high stick of the CFA noted. No complications were noted. On fluoroscopy, US-IL was located significantly lower than FL-IL ( P = .002). On fluoroscopy and completion angiography, US-IL was more strongly correlated (ρ = 0.823, P P = .043). Finally, a "slope-type" CFA was shorter than a "horizontal-type" CFA on US and was more common in patients with low-lying US-IL on fluoroscopy ( P = .001). Conclusions US-guided CFA access with US-IL and femoral head guidance is safe and useful and can be helpful in preventing high stick.