Anatomical Aspect of the Transfemoral Neuroendovascular Approach

Kim, Bum Tae; Shin, Dong Seong

Abstract

To evaluate the safe zone for the use of femoral artery puncture in the clinical practice and to understand the anatomic characteristics of the aortic arch (AA) and its major branches to build a foundation toward performing neuroendovascular surgery safely. The 40 formalin fixed adult Korean cadavers were investigated for inguinal area and AA respectively. The landmarks were the anatomical points on inguinal area and the lengths from each point to the bottom of femoral head (BOFH) were measured using a fluoroscopic view. We investigated several anatomical parameters on the AA, and its major branches with anatomical variations, curvatures, distances. The average length between BOFH and inguinal ligament of the right was 38.9+/-7.2 mm and left was 40.0+/-7.9 mm. The three major branches directly originated from AA in 21 (84%) of the cadavers. Average angle of AA curvature to the coronal plane was 62.2 degrees. Left common carotid artery (LSCA) and left subclavian artery originated from 12.3 mm and 22.8 mm on the left of the mid-vertebrae line. Mean distance from the brachiocephalic truck to the right common carotid artery was 32.5 mm. Mean distance from the LSCA to the left vertebral artery was 33.8 mm. Average angles at which the major branches arise from the AA were 65.3, 46.9 and 63.8 degrees. The safe zone for arterial puncture is considered to 0-20 mm above the BOFH on a fluoroscopic view. This study may provide comprehensive anatomical information to catheterize AA and its branches for safely performing transfemoral neuroendovascular approach.