The femoral artery is a large vessel that provides oxygenated blood to lower extremity structures and in part to the anterior abdominal wall. The common femoral artery arises as a continuation of the external iliac artery after it passes under the inguinal ligament. The femoral artery, vein, and nerve all exist in the anterior region of the thigh known as the femoral triangle, just inferior to the inguinal ligament.
The femoral artery is clinically significant because it’s an access point for many endovascular procedures and a frequent site of peripheral arterial disease (PAD).
Peripheral arterial disease (PAD) is a common circulatory problem that occurs when the blood vessels become narrowed or blocked with plaque over time (which is a condition called atherosclerosis) and reduce blood flow to your limbs. It could happen in any blood vessel but it’s more common in the legs than the arms. The most common sites of involvement are the superficial femoral artery and the common femoral artery.
Symptoms of PAD:
- Claudication (muscle pain or cramping in your legs that’s triggered by activity, such as walking, but disappears after a few minutes of rest. Calf pain is the most common location.)
- Painful cramping in one or both of your hips, thighs od calf muscles after physical activity such as walking or climbing stairs
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared with the other side
- Sores on your toes, feet or legs that won’t heal
- A change in the colour of your legs
- Hair loss or slower hair growth on your feet and legs
- Slower growth of your toenails
- Shiny skin on your legs
- No pulse or a weak pulse in your legs or feet
- Change in sensation
- In end-stage disease, gangrene or necrosis of the digits
The risk factors for peripheral arterial disease are:
- High blood pressure
- High cholesterol
- Age above 60 years
- Sedentary lifestyle
If you have PAD, you are at risk for developing critical limb ischemia, coronary artery disease and cerebrovascular disease, which could lead to a heart attack or stroke.
Diagnosis of peripheral arterial disease
PAD diagnosis begins with a medical history and physical examination. Your doctor will ask you about your symptoms and check the pulses in your legs. He may find signs of PAD like weak or absent pulse below a narrowed area of your artery, whooshing sounds over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb. Also your physical exam may include:
- Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
- Duplex ultrasonography the non-invasive test visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
- Computed Tomographic (CT) Angiography: The non-invasive test uses X-ray and contrast agent (dye) to create pictures of blood vessels in the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
- Magnetic Resonance Angiography (MRA):The test provides cross-sectional images like a CT without using X-rays.
- Angiography: During an angiogram, also called an arteriogram, a contrast dye is injected into the artery and X-rays are taken to show blood flow in the leg arteries to locate any blockages.
In instances where the common and superficial femoral arteries are chronically occluded, extensive collaterals may be present between the deep femoral artery, and thus distal blood flow is more robust than expected. Patients with heavily calcified arteries exhibiting clinical signs and symptoms may require endovascular angioplasty (ballooning) with or without stenting to improve distal blood flow. If an artery is unable to be repaired by endovascular approach, vascular surgeon consultation may be necessary for an arterial bypass procedure.
Treatment of peripheral arterial disease
Treatment for peripheral artery disease has two major goals:
- Manage symptoms, such as leg pain, so that you can resume physical activities
- Stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke
Treatment of peripheral arterial disease includes lifestyle changes, drug therapy as well as minimally invasive endovascular procedures and surgical treatment.
Typically endovascular treatments are used after patients have failed conservative therapy, such as medication and supervised exercise, and are experiencing a limitation in lifestyle due to their disease, such as being unable to work.
Dilatation and stenting of femoral artery
An endovascular procedure is performed inside your artery using a thin, long tube called a catheter. Through a small incision in the groin, the catheter is then guided by the surgeon to the blocked area in the blood vessel. From there, the surgeon will perform an endovascular treatment, such as balloon angioplasty or stenting. In balloon angioplasty, the blocked artery is opened by pressing plaque against the vessel wall with a balloon inserted with a catheter. The balloon is deflated and the catheter is removed. A stent, or mesh wire tubes, may also be placed in the artery following angioplasty to support the cleared vessel and keep it open. This process is usually visualized using x-rays and a special dye that helps reveal the arteries.
Such endovascular approaches are advantageous for many groups of patients. They help younger patients who want the quickest recovery and fastest return to work. A minimally invasive approach can allow qualifying patients to get back to work in two weeks at the most vs. six to eight weeks with an open surgery.