Ultrasound-guided evaluation of the bifurcation of the femoral artery and vein in pediatric patients

Received: October 1, 2008. Accepted: November 18, 2008. Corresponding author: Mijeung Gwak, M.D., Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. Tel: 82-2-3010-3868, Fax: 82-2-470-1363, E-mail: [email protected] Copyright c Korean Society of Anesthesiologists, 2009 Background: The femoral arteries (FA) and femoral veins (FV) are useful access sites for diagnostic and interventional procedures. In adults, the usual puncture sites are 1−3 cm distal from the inguinal crease. In children, however, the optimal puncture site vessels are not known. The aim of our study was to assess the number of branches and bifurcation sites of the femoral vessels in children by using ultrasonography. Methods: Color Doppler ultrasonography was used to determine bifurcation sites of the FA and FV, relative to the inguinal crease, in 48 children (median age, 4 yr; median weight, 18.7 kg) with American Society of Anesthesiologists (ASA) Physical Status (PS) score 1−2 and who were scheduled for general anesthesia. Results: The numbers of FAs and FVs at the inguinal crease were 1.83 ± 0.39 and 1.08 ± 0.29, respectively, in infants, and 1.83 ± 0.58 and 1.0 ± 0.0, respectively, in 10-year-old children. The bifurcation site of the FA in infants and those aged 10 years was 0.78 ± 0.30 cm and 1.47 ± 0.27 cm proximal to the inguinal crease, respectively (P < 0.05), whereas the bifurcation site of the FV in these two age groups was −0.96 ± 0.27 cm and −2.29 ± 1.09 cm distal to the inguinal crease, respectively (P < 0.05). Conclusions: In children, the FA frequently bifurcates proximal to the inguinal crease, whereas the FV bifurcates distal to the inguinal crease. However, there are anatomical differences among age groups, so care should be taken to avoid complications during femoral vessel cannulation. (Korean J Anesthesiol 2009; 56: 290~4)