The descending branch of the lateral femoral circumflex artery is a good option in CABG with arterial grafts

Unilateral Anomalous Profunda Femoris Artery: An Anatomical Variation of Clinical Significance

The profunda femoris artery (PFA) is the largest branch of the femoral artery (FA) in the femoral triangle and is the chief arterial supply for the adductors, flexors, and extensors of the thigh, as well as the hip joint and the femur. Unilateral anomalous origin and variant course of the PFA were observed during the routine cadaveric dissection for undergraduate teaching. Of note, the FA gave only a few muscular branches, whereas all the other significant arteries of the front of the thigh took their origin from the anomalous profunda femoris artery. Both interventional radiologists and surgeons must be familiar with the anatomical variants of the PFA and FA. The likelihood of many sources supplying the skin and pedicle, particularly in reconstructive surgery, requires surgeons to be cognizant of this subject hence crucial in order to minimize surgical complications.

Anatomical Study of the Descending Branch of the Lateral Femoral Circumflex Artery and Veins in Vascular Grafting in Japanese Cadavers

Background:

In microsurgery development, autologous vein grafting is necessary when there are no suitable blood vessels for anastomosis around the flap recipient site or when the vascular pedicle of the flap is short. The descending branches of the lateral femoral circumflex artery (LFCA) and vein have been used as a vascular bundle instead of vein grafts, but to our knowledge, there have been no reports on the relationship between thigh length and vessel length. In this study, we performed a macroscopic examination of the LFCA descending branch length required for grafting.

Methods:

The length of the LFCA descending branches and veins as well as thigh length were measured in 16 preserved cadaveric legs.

Results:

The average length of the thigh was 42.6 cm. It was possible to harvest a mean length of 14.2 cm of the descending branches of the lateral femoral circumflex vessels. Descending branches of the LFCA and veins were identified in all cases. It was estimated that the length of the LFCA descending branch and veins could be collected in 20% of the thigh length in 98% of cases.

Conclusion:

When preparing a preoperative plan, it is important to thoroughly consider the required length of blood vessels for grafting and whether it is possible to harvest vessels with sufficient length.

Descending Branch of the Lateral Circumflex Femoral Artery Graft for Posterior Inferior Cerebellar Artery Revascularization

BACKGROUND

Posterior inferior cerebellar artery (PICA) revascularization can be achieved with relative ease when a contralateral PICA is present. However, without a contralateral PICA, identification of a suitable vessel alternative can be challenging due to a size mismatch.

OBJECTIVE

To propose the descending branch of the lateral circumflex femoral artery (DLCFA) to be an acceptable, if not preferred, arterial graft for PICA revascularization.

METHODS

Data from patients who underwent PICA revascularization with DLCFA grafts were obtained from an institutional review board-approved prospectively maintained database with informed consent from the patients.

RESULTS

Three patients, all presenting with ruptured aneurysms, were treated with PICA revascularization using the DLCFA. All cases achieved bypass patency and no ischemic events occurred during the bypass procedures. Graft spasm occurred in 2 patients. Two patients that presented with neurological deficits achieved excellent neurological outcomes and 1 suffered an anterior spinal artery stroke during a repeat endovascular treatment 1 wk after revascularization.

CONCLUSION

The DLCFA is favorable for PICA revascularization when a contralateral PICA is not a viable option.

The descending branch of the lateral circumflex femoral artery as an alternative conduit for coronary artery bypass grafting: Experience from an anatomical, radiological and histological study

The descending branch of the lateral circumflex femoral artery (DBLCFA) has been suggested as an option for use in coronary artery bypass grafting (CABG). Our aim was to combine radiological examination, surgical and anatomical preparation, and histological assessment of the DBLCFA to map its variability and to assess the benefits of this conduit in cardiac surgery. The pelvic and femoral arteries were examined by CT angiography (CTA) in 100 patients (aged 68.3 ± 9.3 years) to assess the variability of the DBLCFA. Anatomical dissections were performed on 20 cadavers. In 15 patients, an autologous DBLCFA was implanted during CABG. In 35 samples, possible atherosclerotic lesions were examined histologically. The length of the potential DBLCFA conduits measured by CTA was 9.3 ± 2.9 cm, without correlating with the length of the thigh. Anatomical variations that would prevent the DBLCFA from being used in CABG were found in 27 out of 100 patients. Except for focal thickening of the intima, eccentric hypertrophy of the intima was found in three out of 35 samples. No inflammatory infiltration, foam cells, atheroma, or calcifications were found histologically. The DBLCFA is not to be used routinely or in preference to other grafts of choice. However, owing to its moderate variability, sufficient length, caliber, and rare atherosclerosis, it can be used in the absence of other suitable grafts as an alternative conduit implanted as a composite Y-graft end-to-side to the internal thoracic artery in patients without diabetic angiopathy, neuropathy or peripheral artery disease who are undergoing extensive or repeat coronary revascularization. Clin. Anat. 29:779-788, 2016. © 2016 Wiley Periodicals, Inc.

Unusual disposition of lateral circumflex femoral artery: Anatomical description and clinical implications

The anatomical knowledge of arterial variations of lower limb is of utmost significance for the present day surgeons and interventional radiologists for minimizing complications during vascular reconstructive procedures, catheterization procedures and surgical intervention for embolism. Lateral Circumflex Femoral Artery (LCFA) is an important branch of Profunda Femoris artery and precise knowledge of its variations can be of great relevance during surgical and radiological procedures in femoral region. The present study reports a unique case of anomalous route taken by LCFA posterior to femoral nerve associated with a prominent muscular branch from Femoral artery mimicking the course of LCFA. Documentation of such variations is highly significant. It may serve as guideline for surgeons in reducing the incidence of postoperative complications where LCFA is used as a long vascular pedicle in anterolateral perforator thigh flap and in breast reconstruction after mastectomy. Ignorance of such variations can lead to fatal intraoperative haemorrhage and incapacitating sensory and motor deficit due to injury to femoral nerve branches which are closely related to these vessels.