A rare bifurcation of the external iliac artery into femoral and deep femoral arteries

The current cadaveric report describes a quite rare unilateral bifurcation of the external iliac artery (EIA) into two femoral arteries (FAs) of almost equal diameter and parallel course, at the level of the inguinal ligament (IL).

The variant FAs were identified on a 75-year-old formalin-embalmed female cadaver, derived from a body donation program after a signed informed consent.

The EIA bifurcated into a FA and a deep femoral artery (DFA). The DFA extremely high origin was identified at the IL level. Both lateral and medial circumflex femoral arteries originated from the DFA.

The in-depth knowledge of the FA variant origin is of paramount importance to vascular surgeons and interventional radiologists during vessel catheterization and attempts to interpret the angiographic findings. In particular, the DFA’s high origin from the EIA and the coexistence of two FAs in a parallel course may pose problems to clinicians during angiographic procedures leading to diagnostic errors. The DFA high origin may also complicate femoral arterial and venous puncture and femoral nerve blocks, due to the close neurovascular relationship. There is a possibility for the FA to be mistaken for a vein leading to accidental intra-arterial injection and consequently thrombosis. Thus, variable arterial pattern is important to be identified preoperatively using Doppler ultrasound imaging.