Where is this lesion?

With increasing popularity of using vascular closure devices following cardiac and peripheral catheterization , cardiologists are encountering a variety of anatomic and pathologic femoral vascular findings. Before applying a closure device, it is important to first evaluate the femoral artery anatomy to ensure its suitability for using a closure device regardless of device type. Knowledge of the femoral artery anatomy around the femoral head is important. The common femoral artery arises as continuation from the external iliac arteries . At about the level of the femoral head, the Common Femoral Artery bifurcates into the Superficial Femoral Artery (SFA) andthe Deep (profunda) femoral artery (PFA) . The SFA in turn course down the thigh and ultimately transitions into the popliteal artery before the popliteal in turn trifurcates into the anterior and posterior tibial arteries and peroneal artery supplying blood to the calf and foot. The PFA provides circumferential blood supply to the deep muscles of the upper thigh and femur and also supples important collateral flow to the lower thigh and leg when the SFA is narrowed or occluded. When peripheral vascular disease affects the common femoral artery or the bifurcation itself, the lower leg is at particularly high risk of losing its major arterial supply. For this reason, it is imperative to understand this anatomy.

Usually, an oblique RAO or LAO angiographic projection is necessary to optimally define this important anatomy. As shown above, sometimes additional views are required to precisely define the extent of disease. Above, it appears that the lesion is isolated to the common femoral artery. However, as can clearly be seen in the photo below, the lesion actually extends into both the Superficial and Profunda arteries.