Introduction

Systems of extracorporeal life support may be integrated with patient's vascular system both by central access (in the area of thorax) or a peripheral one. The basic criterion for choice of place of catheterisation is the vessel's diameter. Technological advancement has enabled reduction of catheter size with maintenance of adequate volume of blood circulating in the system. This, in turn, enables efficient support and even full substitution of circulation via peripheral access. Most often chosen catheterisation vessels are femoral vessels, less often external iliac artery, common carotid artery and subclavian artery. Apart from the diameter, anatomic topography and patient's clinical condition are further factors for choice of catheterisation place.

Femoral access

Femoral artery is a continuation of external iliac artery and the main vessel supplying blood to lower limb. Lingual ligaments divide external iliac artery from femoral artery.

The initial portion of the artery is located on frontal side of the thigh, on rear lamina of fascia lata, within femoral triangle. It is covered by superficial lamina of fascia lata and is adjacent to femoral nerve laterally and medially to femoral vein. In this location it approximates body surface, what enables the pulse palpation, whilst exerting pressure and depressing it towards illiopubic eminence makes occlusion of its lumen possible.

Surgical procedure

Patient is placed in supine position, extensive area covered with surgical drapes enables conversion to other peripheral vessels. Skin incision is usually vertical, less often horizontal or diagonal, parallel to inguinal ligament, directly above femoral artery when pulse is palpable.

In lack of presence of palpable pulse incision should be slightly medial to mid-section of inguinal ligament. Vertical incision is extended above groin, so 1/3 of the incision is above inguinal ligament and 2/3 below it. After the incision, subcutaneous tissue is exposed, fascia is incised and vascular complex is revealed – femoral artery and vein. After obtaining access to femoral artery (loop, thick suture), assessment of vessel diameter and condition of vessel wall the appropriate catheter size is chosen.