The term transfemoral describes a medical approach that means “through the femoral artery,” providing physicians with a gateway to the body’s network of blood vessels. It is a form of minimally invasive access, allowing for a range of diagnostic and therapeutic procedures without the need for large surgical incisions. By using this route, instruments can be navigated to various locations inside the body, including the heart, brain, and limbs.
The Transfemoral Access Point
The access point for this approach is the common femoral artery, a major blood vessel located in the groin area. This artery is chosen because its diameter is relatively large, which allows it to accommodate the thin, flexible tubes called catheters used in these procedures. The vessel’s size is also sufficient for larger devices required for complex interventions like valve replacements.
Another reason for its selection is its superficial position, meaning it lies closer to the skin’s surface, making it more accessible for a physician to puncture safely. Furthermore, the common femoral artery passes over the solid bone of the femoral head. This provides a firm surface against which a doctor can apply pressure after the procedure to seal the puncture site and prevent bleeding.
Common Transfemoral Procedures
One of the most frequent uses of the transfemoral approach is for coronary angiography. During this diagnostic procedure, a catheter is guided from the femoral artery to the heart, where a special dye is injected into the coronary arteries. X-ray imaging then captures how the dye moves through the vessels, revealing any narrowings or blockages. This detailed map helps physicians determine the extent of coronary artery disease.
If blockages are identified, the approach can be used for treatment. Percutaneous coronary intervention, known as angioplasty and stenting, involves advancing a tiny balloon to the site of the blockage. The balloon is inflated to compress the plaque, and often a small mesh tube called a stent is deployed to hold the artery open and restore blood flow.
More complex structural heart repairs are also performed using this route. Transcatheter Aortic Valve Replacement (TAVR) is a procedure for a diseased aortic valve. A new, collapsible replacement valve is delivered through the catheter to the heart, where it is expanded into place within the old valve. This avoids open-heart surgery, making it an option for patients at higher risk for traditional surgical procedures.
This medical approach should not be confused with a transfemoral amputation, which is the surgical removal of the leg above the knee joint. This operation is performed due to severe trauma, infection, or diseases that have damaged the limb beyond repair. While both terms use the “transfemoral” prefix, the access approach is a minimally invasive entry into the vascular system, whereas the amputation is a major surgical removal of a limb.
The Patient Experience
On the day of a transfemoral procedure, preparation occurs in a specialized room, often a catheterization laboratory. A local anesthetic is injected into the groin area to numb the access site. Many patients also receive conscious sedation, a light to moderate sedative administered intravenously to promote relaxation. This allows the patient to remain awake but drowsy.
Once the area is numb, the physician makes a small puncture with a needle to enter the femoral artery. A short, hollow plastic tube called an introducer sheath is then placed into the artery. This sheath acts as a stable port for the longer catheters and instruments. Patients do not feel the catheters moving through their blood vessels, as the inside of arteries lacks nerve endings.
Throughout the procedure, the medical team uses imaging techniques, such as fluoroscopy (a real-time X-ray), to watch the catheter’s progress on a monitor. This allows them to guide the instruments with precision to the target location. After the diagnostic or therapeutic part of the procedure is complete, the catheters are withdrawn.
The final step is the removal of the sheath and the closure of the puncture in the artery. This is accomplished either by applying firm, direct manual pressure or by using a vascular closure device. These devices deploy a small plug, clip, or stitch to seal the opening. Following the procedure, patients lie flat for several hours to minimize the risk of bleeding.
Recovery and Potential Complications
The recovery period following a transfemoral procedure involves a short hospital stay and some activity restrictions for a few days. Patients are advised to avoid strenuous exercise, heavy lifting, and driving for a brief period to allow the access site in the groin to heal fully. Most people can return to their normal routines relatively quickly.
Although the approach is safe, complications related to the access site can occur. The most common issue is bleeding or a hematoma, which is a collection of blood under the skin appearing as a large bruise. A rapidly expanding swelling at the puncture site requires immediate medical attention. Prompt evaluation of any of the following symptoms is important for preventing more serious issues:
- A pseudoaneurysm, which is a contained leak from the artery that forms a pulsating sac of blood.
- An arteriovenous fistula, an abnormal connection between the artery and a nearby vein.
- Signs of infection, such as increasing redness, warmth, swelling, or drainage from the puncture site, accompanied by a fever.