Anatomical localization of the common femoral artery relative to palpable bony landmarks in the pediatric population

Abstract

Aims: The aim of this study was to evaluate the anatomical location of the common femoral artery (CFA) relative to palpable bony landmarks in pediatric patients using computed tomography angiography (CTA), to determine age-related changes in its position across pediatric age groups, and to assess potential differences compared with the anatomical location described in the adult population. Methods: Lower extremity CTA images of pediatric patients aged ≤16 years were retrospectively analyzed. Patients with trauma, tumors, skeletal deformities, or inadequate image quality were excluded. A total of 55 patients were included in the final analysis. Three-dimensional volume-rendered reconstructions were used to evaluate the morphometric relationship between the CFA and pelvic bony landmarks. Distances between the anterior superior iliac spine (ASIS), symphysis pubis (SP), greater trochanter (GT), and CFA were measured on the anteroposterior plane. Patients were divided into three age groups (0-6, 7-12, and 13-16 years). The relative position of the CFA along the ASIS-SP and GT-SP reference lines was calculated as percentages. Results: A total of 55 pediatric CTA examinations were analyzed (mean age 10.56±4.58 years). The cohort included 25 females (45.45%) and 30 males (54.55%). Significant differences were observed in the relative position of the CFA along the ASIS-SP line among age groups (p<0.001). The CFA was located more laterally in the 0-6 year group (53.57% of the ASIS-SP distance), closer to the midpoint in the 7-12 year group (49.65%), and more medially in the 13-16 year group (47.71%). A similar pattern was observed along the GT-SP line, where the artery was positioned laterally in younger children (59.38%) and progressively approached the midline or medial side with increasing age (50.87% and 49.23%, respectively). Conclusion: The anatomical location of the CFA relative to bony landmarks changes with age in pediatric patients. The artery tends to be located more laterally in younger children and shifts relatively medially with increasing age. These findings suggest that adult anatomical landmarks may not always be reliable for femoral vascular access in pediatric patients and highlight the importance of age-specific anatomical considerations.