Mid-inguinal Point Research Articles

Is the mid-inguinal point an accurate landmark for the common femoral artery in vascular patients?

An accurate guide to the common femoral artery (CFA) is important in vascular patients as the CFA pulse may not me palpable. At least four different descriptions of the surface anatomy of the CFA are given in standard anatomic texts. This study was undertaken to determine the accuracy of the mid-inguinal point as a guide to the CFA in patients undergoing femoral arteriography. The surface anatomy of the CFA was determined using true anteroposterior arteriograms of 30 patients [20 men, 10 women, age (mean +/- s.d.) 67 +/- 6.8 years, range 56-82]. The distance between the anterior superior iliac spine (ASIS) and the symphysis pubis was measured with callipers and defined as the inguinal distance [(mean +/- s.d.) 16.03 +/- 1.06 cm, range 14.00-18.50]. The midpoint of this line defined the mid-inguinal point. Similarly, the distance was measured from the symphysis pubis to the midpoint of the CFA where it crossed the inguinal line on the arteriogram, and was defined as the femoral distance [(mean +/- s.d.) 7.99 +/- 0.51 cm, range 6.80-9.00]. The location of the CFA coincided with the mid-inguinal point in only six (10%) of the 60 measurements. The difference between the CFA and mid-inguinal point varied from 1.25 to 1.50 cm either side of the mid-inguinal point, and in six (10%), the difference was 1 cm more, and therefore of clinical significance. On the basis of these findings we conclude that the relationship between the mid-inguinal point, found using bony landmarks, is an appropriate guide to the CFA as it can be expected to lie within 1.5 cm either side of the mid-inguinal point. The natural variability observed could account for the different anatomical descriptions of the surface anatomy of the CFA. No exact definition may be possible.

Abdominoinguinal incision in resection of pelvic tumors with lateral fixation

Large tumors in the area of the iliac fossa, external iliac vessels, wall of the lesser pelvis, and pubic bone are often considered unresectable through conventional abdominal incisions due to the lack of exposure, or they are managed with hindquarter amputation. The abdominoinguinal incision provides the necessary exposure for en-bloc resection of many of these tumors. It involves a lower midline incision that is extended transversely to the mid-inguinal point on the side of involvement and then vertically, over the course of the femoral vessels, which are exposed. The rectus abdominis is divided off the pubic crest and the inguinal ligament off the pubic tubercle, and the inferior epigastric vessels are ligated and divided at their origin. This allows in-continuity exposure of the lower abdomen, pelvis, and the groin in one field and dramatically improves the exposure.

Anatomy of percutaneous femoral artery puncture

The paper by Grier and Hartnell (1990) discusses the use of the inguinal skin crease and the site of maximal pulsation in femoral artery puncture, but omits mention of the mid-inguinal point. Defined as being “midway between the anterior superior iliac spine and the symphysis pubis”, this point is traditionally held by anatomists to be the most accurate landmark in locating the common femoral artery (Williams & Warwick, 1980). The anatomical accuracy of the mid-inguinal point was tested by studying 10 adult cadavers, using one side only on each. A tape measure was placed accurately between the two points and the exact mid-point marked on skin. (As the symphysis pubis was impossible to palpate through embalmed skin it was located by a limited dissection.)

Anatomical mythology? A study of surface markings of the inguinal region

AbstractThe surface markings used by authors for structures in the inguinal region were reviewed and differences noted. In this study of 40 cadaveric limbs the surface markings of both the deep inguinal ring and the femoral artery were found to lie closer to the midinguinal point than to the midpoint of the inguinal ligament, which lay lateral to both structures considered. Usually the femoral artery was located lateral to the medial margin of the deep inguinal ring, but occasionally lay medial. In some subjects poor definition of the bony features rendered precise localisation of the positions of the pubic tubercle and anterior superior iliac spine difficult. The origin of the inferior epigastric artery, often used to identify the medial margin of the deep inguinal ring, was subject to variation. A single surface marking, namely the midinguinal point, is suggested for both the femoral artery and the deep inguinal ring on grounds of accuracy, simplicity, and ease of identification.