ABSTRACT
Femoral artery puncture is the standard approach in gaining access to the left heart. The common femoral artery should be punctured in preference to the superficial or profunda (see Figure 5.1). The technique used to cannulate this vessel is germane to arterial puncture elsewhere in the body. The Seldinger technique is used. First the vessel is located by palpating below the inguinal ligament in the region of the inguinal skin crease. The ideal position for puncture is approximately 2 inches below the inguinal ligament and slightly lateral to the position of the vessel. This approach increases the chances of cannulating the common femoral artery and not the superficial femoral or profunda. This minimizes the frequency of local vascular complications. Puncture of the artery at or above the inguinal ligament makes catheter advancement difficult and predisposes to inadequate compression, haematoma formation and retroperitoneal bleeding following sheath removal. Puncture of the artery more than 3 cm below the inguinal ligament increases the chance that the superficial femoral or profunda is punctured, increasing the risk of false aneurysm formation or thrombotic occlusion due to small vessel calibre. Because the superficial
femoral artery frequently overlies the femoral vein, low venous punctures may pass inadvertently through the superficial femoral artery, leading to excessive bleeding and possibly arteriovenous fistula formation.
