From the Guidelines
A femoral bruit is typically caused by arterial stenosis or occlusion, particularly in the context of peripheral arterial disease (PAD), as suggested by the ACC/AHA Practice Guidelines 1. The presence of a femoral bruit indicates turbulent blood flow, which is often associated with inflow disease, referring to stenotic or occlusive lesions in the suprainguinal vessels, such as the infrarenal aorta and iliac arteries 1. This can lead to diminished blood flow to the common femoral artery, resulting in symptoms like gluteal or thigh claudication and femoral pulse diminution or bruit. Key points to consider when evaluating a femoral bruit include:
- The patient's symptoms, such as claudication, and the location of the pain (e.g., buttock, thigh, or calf) 1
- The presence of other physical examination findings, like diminished pulses or coolness of the affected limb
- The need for further vascular assessment, including ankle-brachial index (ABI) measurement, to confirm the diagnosis of PAD
- Comprehensive cardiovascular risk assessment, as PAD often coexists with coronary and cerebrovascular disease Management of patients with femoral bruits typically involves addressing modifiable risk factors, such as smoking cessation, blood pressure control, diabetes management, and cholesterol reduction with statins, as well as antiplatelet therapy with aspirin or clopidogrel 1. Severe stenosis may require referral to vascular surgery for potential intervention.
From the Research
Causes of Femoral Bruit
- A femoral bruit is a vascular sound heard over the femoral artery, which can be an indication of underlying atherosclerotic disease or stenosis 2
- The presence of a femoral bruit has been shown to provide information on the presence of significant femoral plaque and ankle-brachial index (ABI) <0.9, independent of cardiovascular risk factors 2
- Atherosclerotic stenosis of the common femoral artery (CFA) is a common cause of femoral bruit, and can be treated with endovascular interventions or common femoral endarterectomy (CFE) 3
Diagnostic Methods
- Auscultation for femoral bruits and pulse palpation can provide valuable information on the presence of asymptomatic peripheral arterial disease (PAD) and underlying atherosclerosis 2
- Duplex ultrasound (DU) criteria, such as peak systolic velocity (PSV) and velocity ratios (Vrs), can be used to assess in-stent stenosis after angioplasty and stenting of the superficial femoral artery 4
- Vector flow imaging (VFI) is a potential diagnostic tool for the assessment of atherosclerosis and peripheral arterial disease, and can provide information on flow complexity and velocity in the superficial femoral artery 5
- Biplanar angiography and Doppler signal analysis can also be used to detect arterial stenosis and assess the severity of disease 6