Femoral artery catheterization (FAC) is a common medical procedure where a thin, flexible tube, known as a catheter, is inserted into the large artery located in the groin area. This minimally invasive technique provides access to the body’s circulatory system, allowing physicians to perform various diagnostic and treatment procedures. The process involves temporarily introducing the catheter into the femoral artery to reach distant vessels and organs.
The Purpose of Femoral Catheterization
The femoral artery is frequently selected for this procedure because of its large diameter and superficial location near the groin, making it relatively easy to access. This vessel offers a direct pathway into the aorta, the body’s main artery, leading to the heart and other major organs. The size of the artery also accommodates the larger specialized devices sometimes necessary for complex therapeutic interventions.
Procedures performed through this access site are diagnostic or interventional. Diagnostic uses include angiography, where a dye is injected to visualize the blood vessels and identify blockages or narrowing within the coronary or peripheral arteries. Catheters can also measure pressures within the heart chambers to aid in diagnosing heart conditions.
Interventional procedures involve therapeutic applications, such as percutaneous coronary intervention (PCI), including angioplasty and stenting. The femoral artery is also used for placing large-bore devices, like those used for temporary cardiac support or specialized structural heart procedures.
Step-by-Step Procedure Description
Before the procedure, the patient is positioned on a table, and the groin area is cleaned and covered with sterile drapes. A local anesthetic is administered to numb the skin and deeper tissues at the puncture site. While the patient stays awake, mild sedation may be provided to help them relax.
The physician locates the common femoral artery, often using ultrasound guidance to ensure precise needle placement. The ideal puncture point allows the vessel to be compressed against the bone to control bleeding later. A small needle punctures the artery, and upon successful entry, a thin guidewire is carefully threaded through the needle and into the artery.
The needle is removed, and a short, hollow plastic tube called a sheath is advanced over the guidewire and into the artery. This sheath remains in place, serving as a stable conduit for introducing and exchanging various catheters and devices. Once secured, the specialized catheter is advanced through it and navigated toward the target area, such as the heart.
The entire process is visualized in real-time using fluoroscopy, a type of X-ray that displays a continuous moving image. A contrast dye is injected through the catheter to make the blood vessels visible, allowing the physician to precisely steer the catheter. Once the procedure is complete, the catheter and sheath are carefully removed.
Immediate Post-Procedure Care
The most immediate concern after removing the sheath is achieving hemostasis, which means stopping the arterial bleeding at the puncture site. Because an artery is under high pressure, hemostasis is achieved either through manual compression or by using a vascular closure device.
Vascular closure devices are small implants that seal the hole in the artery with a suture, clip, or collagen plug. Regardless of the technique used, the patient must remain completely flat in bed for a period, typically ranging from two to six hours, to allow the artery to seal effectively. This flat positioning minimizes stress on the groin and prevents re-bleeding.
During this recovery phase, the nursing staff monitors the patient’s vital signs and checks the puncture site for bleeding or swelling. The patient may notice localized tenderness, bruising, or a small, firm lump beneath the skin, which is often a hematoma that the body will reabsorb naturally. Patients are instructed to keep the affected leg straight and still, avoiding sitting up or flexing the hip.
Recognizing and Addressing Complications
Patients should be aware of potential complications. The most common issues are related to the access site, including the formation of a hematoma (bruising or a painful lump at the groin). A more serious, though less frequent, complication is a pseudoaneurysm, a contained sac of blood forming outside the artery wall at the puncture site.
A puncture that is too high above the inguinal ligament increases the risk of retroperitoneal hemorrhage, which is potentially life-threatening bleeding into the abdominal space. Other issues include an arteriovenous fistula (an abnormal connection between the artery and the adjacent vein) or an allergic reaction to the contrast dye used during the procedure.
Patients must be vigilant for certain signs and symptoms after returning home. These warning signs require immediate medical attention:
- Sudden, heavy bleeding from the puncture site that cannot be stopped with firm pressure.
- A rapid, painful swelling of the groin.
- Signs of reduced blood flow to the limb, such as severe pain, coldness, numbness, or a bluish discoloration in the leg or foot.
- Any fever or persistent discharge from the wound site, which could signal an infection.