Learning from the femoral vein puncture trouble .

Congress:

ECR 2018

Poster Number:

C-0932

Type:

Educational Exhibit

Keywords:

Anatomy, Emergency, Interventional vascular, CT, CT-Angiography, Venous access, Puncture, Complications, Acute, Haemorrhage, Trauma

Authors:

R. Abe¹, Y. Hori², Y. Tashiro³, N. Mizobuchi¹, J. Munechika¹, N. Takeyama⁴, T. Hashimoto⁴, T. Gokan¹; ¹Tokyo/JP, ²Suita, Osaka/JP, ³Yokahama/JP, ⁴Yokohama/JP

DOI:

10.1594/ecr2018/C-0932

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0932

Fig. 1: A hematoma that developed in the right inguinal region

Fig. 2: The inferior epigastric artery was considered damaged.

Fig. 4: We divided the femoral head into three zones (Zones A, B, and C) from the...

Fig. 5: The number of patients with inferior epigastric artery that cuts across the...

Learning objectives

We encountered a case of a patient who was in shock because of a hematoma that developed in the right inguinal region when femoral vein puncture was performedatour hospital. Computerized tomography (CT) was performed to explore the cause, which was suspected to be damage to the blood vessels running across the front of the femoral vein. The inferior epigastric artery was considered damaged. We examined the positional relationship between the inferior epigastric artery and the femoral vein and describe a safe puncture point for the...

Background

The inferior epigastric artery is a branch of the external iliac artery. It normally branches off from the part just above the inguinal ligament to run behind the lower abdominal wall in an upward and inward direction. In some cases, the inferior epigastric artery first runs in the caudal direction and then runs up in the cranial direction.

Findings and procedure details

Eighty-three patients receiving contrast-enhanced CT( slice thickness: 0.75〜1.25mm) prior to EVAR (Endovascular Aneurysm Replacement) at our hospital or affiliated hospitals were examined. The femoral head was divided into three zones (Zones A, B, and C) from the cranial side to the caudal side in order to examine the positional relationship between the femoral head and the level at which the inferior epigastric artery cuts across the front of the femoral vein. The number of patients with inferior epigastric artery that cuts across the front of...

Conclusion

Cases in which the inferior epigastric artery cuts across the front of the femoral vein at the center level of the femoral head were found in 30% or more of the patients. Thus, we considered that femoral vein puncture at the same level was associated with the risk of erroneously puncturing the inferior epigastric artery. Moreover, puncturing a site extremely far away on the caudal side as a result of too much attention to the inferior epigastric artery may possibly result in puncturing the external...

Personal information

References

Michael Schuenke et al. Atlas of Anatomy second edition. Thieme Medical Publishers Lorenzo Azzalini et al. The wise radialist's guide to optimal transfemoral access Selection, performance, and troubleshooting. Catheter Cardiovasc Interv89 (3),399-407. 2016 May 24. 　