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GENERAL CONSIDERATIONS/INTRODUCTION AND BACKGROUND
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The common femoral artery (CFA) is unique and different in many ways from other peripheral extremity vessels. It is located at a very mobile flexion position between the torso and the lower extremity, which can affect the long-term durability of any open repair and severely limits the applicability of currently available endovascular technologies for repair. The profunda femoral artery (PFA) also originates from the common femoral artery early in the proximal thigh and is an important vessel that can assist in supporting the viability of the leg in situations in which the superficial femoral artery (SFA) is acutely or chronically occluded. Penetrating injuries to the CFA/profunda represent only 10% to 15% of the total found of all those in the femoral system and experience has shown them to usually present with hard signs of vascular injury.1–3 Although these vessels are typically amenable to open repair, careful dissection is often needed. Proximal control can be difficult in the context of emergent exposure and control since the external iliac artery proximally dives deeply into the pelvis above the inguinal ligament.
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The popliteal artery can be considered a terminal artery for the perfusion of the lower extremity. As such, injury in this location is associated with the highest risk of limb loss of all extremity vascular injuries. The location of the popliteal artery posterior to the knee puts it at risk of injury from both blunt and penetrating mechanisms. While characteristically a concern among blunt posterior knee dislocations, popliteal artery injuries caused by penetrating mechanisms are more common. Amputation rates associated with popliteal artery injury are reported in 13% to 30% across several series.4–6 Even among those patients undergoing successful management of the arterial injury after trauma, associated functional deficits caused by concomitant injuries to nerves and connective tissue are common.
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Both the common femoral artery and the proximal profunda lie within the femoral triangle bounded superiorly by the inguinal ligament, medially by the adductus longus muscle, and laterally by the sartorius muscle (Fig. 14-1). The floor consists of the fascia overlying the ilio-psoas and the pectineus muscles. The profunda artery generally branches 2 to 3 cm below the inguinal ligament and then travels several centimeters until it is posterior under the adductor longus (Fig. 14-2). Other significant named branches of the CFA include the lateral superficial and deep circumflex iliac arteries, the medial inferior epigastric arteries (at the inguinal ligament), and the medial circumflex arteries. Although usually a major branch of the profunda, the lateral femoral circumflex may originate off the CFA and can substantially enlarge enough as a collateral to sustain the viability of a chronically ischemic leg. Nerves of concern include the larger femoral nerve laterally and the superficial ...