Endovascular management of femoral artery duplication with a proposed anatomical classification.

PURPOSE: Duplication of the femoral artery (FA) is an exceedingly rare anatomic variant, and its implications for endovascular therapy are poorly defined. We report endovascular revascularization for chronic limb-threatening ischemia (CLTI) in a duplicated FA and propose a classification system for these duplications.

METHODS

An 80-year-old woman presented with lower extremity CLTI and underwent computed tomographic angiography (CTA) followed by endovascular treatment of the FA stenosis. In addition, previously published reports of FA duplication were reviewed to characterize anatomic patterns and inform a classification system.

RESULTS

Computed tomographic angiography demonstrated a duplicated left FA with critical serial stenoses of the internal limb and severe disease near the distal confluence. Selective angiography confirmed two diminutive, parallel FA limbs with occlusion at the adductor canal near their coalescence and collateral reconstitution of the popliteal artery. The diminutive internal limb was successfully cannulated and used to traverse the occlusion. Orbital atherectomy followed by balloon angioplasty restored inline flow with minimal residual stenosis, resulting in durable limb salvage.

CONCLUSION

A duplicated FA can complicate endovascular recanalization because of the diminutive caliber of the arterial limbs. We identified five patterns of FA duplication in the literature. Type 1 represents partial duplication of the FA distal to the origin of the deep femoral artery, with subsequent reunion proximal to the adductor hiatus, a pattern similar to that observed in our patient. Including the present report, only 21 cases of type 1 FA duplication have been reported in the literature since the early nineteenth century.