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An accurate guide to the common femoral artery (CFA) is important in vascular patients as the CFA pulse may not be palpable. At least four different descriptions of the surface anatomy of the CFA are given in standard anatomic texts. This study was undertaken to determine the accuracy of the mid-inguinal point as a guide to the CFA in patients undergoing femoral arteriography.The surface anatomy of the CFA was determined using true anteroposterior arteriograms of 30 patients [20 men, 10 women, age (mean ± s.d.) 67± 6.8 years, range 56-82].The distance between the anterior superior iliac spine (ASIS) and the symphysis pubis was measured with callipers and defined as the inguinal distance [(mean ± s.d.) 16.03 ± 1.06 cm, range 14.00-18.50]. The midpoint of this line defined the mid-inguinal point. Similarly, the distance was measured from the symphysis pubis to the midpoint of the CFA where it crossed the inguinal line on the arteriogram, and was defined as the femoral distance [(mean ± s.d.) 7.99 ± 0.51 cm, range 6.80-9.00]. The location of the CFA coincide with the mid-inguinal point in only six (10%) of the 60 measurements. The difference between the CFA and mid-inguinal point varied from 1.25 to 1.50 cm either side of the mid-inguinal point, and in six (10%), the difference was 1 cm or more, and therefore of clinical significance.On the basis of these findings we conclude that the relationship between the mid-inguinal point and the CFA is not exact in vascular patients undergoing arteriography. The mid-inguinal point, found using bony landmarks, is an appropriate guide to the CFA as it can be expected to lie within 1.5 cm either side of the mid-inguinal point. The natural variability observed could account for the different anatomical descriptions of the surface anatomy of the CFA. No exact definition may be possible.