What is the procedure for performing a femoral artery cutdown?

From the Guidelines

To perform a femoral artery cutdown, the procedure involves exposing the upper thigh through an inguinal to knee incision, removing a proximal part of the femoral artery after double ligation, isolating and coagulating all side branches, and removing the whole artery in between the proximal and distal ligation sites, as described in the most recent and relevant study 1.

Key Steps:

• Expose the upper thigh through an inguinal to knee incision
• Remove a proximal part of the femoral artery after double ligation
• Isolate and coagulate all side branches
• Remove the whole artery in between the proximal and distal ligation sites

Important Considerations:

• The procedure requires sterile technique and appropriate instruments, including vascular clamps and suture material
• Complications can include bleeding, infection, pseudoaneurysm formation, and nerve injury
• The femoral cutdown is a valuable procedure in emergency situations, such as trauma resuscitation or when percutaneous access fails, as it provides reliable access to large-caliber vessels for fluid resuscitation, central venous access, or arterial monitoring, as supported by studies 1 and 1

Additional Details:

• The use of percutaneous closure devices and lower profile endovascular stent grafts has made ultrasound-guided percutaneous access and closure more feasible, as noted in 1
• However, the femoral cutdown remains a crucial procedure in certain situations, and its technique should be mastered by healthcare professionals, with the most recent and highest quality study 1 providing the basis for the recommended procedure.

From the Research

Procedure for Performing a Femoral Artery Cutdown

The procedure for performing a femoral artery cutdown involves several steps, including:

• Exposure of the femoral artery through a surgical incision, which can be either transverse or vertical 2
• Identification and clamping of the femoral artery and vein 3
• Catheterization of the femoral artery for insertion of devices or sheaths 4
• Closure of the incision site, which can be done using suture-mediated closure devices or other methods 5

Key Considerations

Some key considerations when performing a femoral artery cutdown include:

• The choice of incision type, with transverse incisions potentially resulting in fewer surgical wound infections than vertical incisions 2
• The size and patency of the femoral artery, with a minimal diameter of 6mm recommended for superficial femoral artery access 4
• The risk of complications, such as bleeding, ischemia, and venous injury, which can be minimized with careful technique and patient selection 4

Alternative Approaches

Alternative approaches to femoral artery cutdown include:

• Percutaneous access, which can be faster and less invasive but may have a higher risk of complications 5
• Iliac exposure, which may be necessary in cases of inadequately sized external iliac vessels but can be associated with increased morbidity and operative time 5
• Use of internal conduits or endoconduits, which can be useful in certain cases but have limited published experience 5