What is the appropriate landmark for a femoral artery puncture?
Some risks of arteriography can be minimized by properly selecting the puncture site. Above the inguinal canal, the common femoral artery becomes the external iliac artery and dives posteriorly. Punctures above the inguinal canal may be problematic for several reasons. Because the artery is deep in relation to the puncture site, manual compression may be difficult, leading to a hematoma or arterial pseudoaneurysm. In the event of an access site complication that requires surgical intervention, the surgical approach for puncture above the inguinal ligament is more involved. A puncture that is too low may result in an arteriovenous fistula (AVF). The inguinal crease is a landmark that is commonly used for femoral artery puncture, but this is a very inaccurate estimate for the location of the inguinal ligament, especially in obese patients. The best landmark is the middle of the medial third of the femoral head identified fluoroscopically ( Figure 70-1 ). Ultrasonography (US) may also be used to guide access.