Anatomical variability of the deep femoral artery

Abstract

Introduction: The deep femoral artery (DFA) serves as a crucial „turning point” between collateral circulation of the pelvis and that of the lower limb (LL), playing a determinant role not only in femoropopliteal axis obstruction, but also in aortoiliac obstructive disease. Choice of the surgical method depends on surgeon's experience, intraoperative anatomical situation and a significant role is atributed to the variability of the deep femoral artery. The aim of our study was to investigate the anatomical variants of the deep femoral artery depending on gender and laterality. Materials and methods. The variability of the deep femoral artery (DFA), as the main collateral branch of the femoral artery (FA) was studied on 40 lower limb angiographies, taken from the database of the Endovascular Surgery Department of MSPI CRH Timofei Moșneaga. All the angiographies of the study sample size belonged to patients without any arterial pathology. The analysis of the lower limb arterial angiographies aimed to translate the anatomy of the DFA from the virtual model to the real one, in order to identify its variability based on gender and laterality, according to the studied criteria: origin, numerical variations and branching pattern. Results. Eleven patients (27.5%) had different variants of the deep femoral artery, out of which 7 patients (17.5%) were males (12.5% with variants of the right LL and 5% with variants of the left LL), and 4 patients (10%) were females (7.5% with variants of the right LL and 2.5% with variants of the left LL). Variability of the DFA origin was identified in 10.0% of cases (high origin in 7.5% and low origin in 2.5%). In 5.0% of cases numerical variants were determined and in 12.5% variants of branching pattern were revealed. The following variants of the DFA branching pattern were established: 1. Bifurcation of the DFA into two branches – the medial circumflex femoral artery (MCFA) and the lateral circumflex femoral artery (LCFA), was identified in 5% of cases; 2. The DFA gave rise to the LCFA and three perforating arteries (PA), while the MCFA in 5.0% of cases derived from the femoral artery (FA); 3. The DFA gave rise to the MCFA and three PA, while the LCFA in 2.5% of cases started from the femoral artery (FA). Conclusions: The deep femoral artery is more frequently variable in males, and on the right side. To enhance the safety and efficacy of any procedures performed at the thigh level, it is crucial to be aware of the deep femoral artery anatomical variability.