Deep Femoral Artery Identification Using Contrast-Enhanced Computed Tomography Images for the Verification of Vascular Injury Risks in Hip Surgery

Iatrogenic deep femoral artery (DFA) injury is a serious complication of hip surgery, often resulting from screw or wire placement in the femur owing to the limited visibility of the DFA and its branches during femoral penetration. We aimed to identify the course and location of DFA perforating branches using an imaging-based approach to improve surgical planning and prevent vascular injury during hip procedures, which has not been thoroughly evaluated in prior anatomical studies. We consecutively enrolled 20 female and 20 male participants with unilateral hip osteoarthritis. Contrast-enhanced computed tomography images of the unaffected side were used to identify the DFA. Associations between participant demographics and DFA branch location and trajectory were analyzed. The distance from the apex of the greater trochanter (GTR) to the first DFA perforating branch was significantly shorter in females than in males (mean: 100 (range, 77-122) vs. 113 (range, 99-131) mm, P < 0.001), whereas no significant difference was found for the second branch (mean: 154 (range, 108-242) vs. 160 (range, 128-235) mm, P = 0.73]. The DFA ran within 5 mm of the femur on the medial-posterior aspect at 140 mm and 200 mm distal to the apex of the greater trochanter, typical insertion sites for distal cortical screws in intramedullary nailing for hip fractures. In females, the first DFA perforating branch occurs more proximally than in males, necessitating caution during femoral wiring at this level. These findings help refine anatomical understanding of the DFA course, supporting safer surgical planning for intramedullary fixation. The small sample size (n = 40) is one of the limitations and may affect generalizability.