Detection of corona mortis during femoral vein puncture for electrophysiology procedures using doppler ultrasound
K Kassa, R PapAbstract
Background
The corona mortis is an anatomical variant connecting the external iliac and obturator arterial networks. Its clinical relevance is well established in trauma and surgical settings, as inadvertent injury can result in significant, and sometimes occult haemorrhage. Anatomical, surgical, and angiographic studies estimate its incidence at 20–30%, yet its visualisation by ultrasound (US) has not been systematically assessed. The vessel may also have implications for invasive electrophysiological procedures, as its proximity to the femoral vein (FV) may predispose to puncture-related complications.
Objective
To assess the incidence and detectability of the aberrant corona mortis artery within the femoral triangle using Doppler ultrasound during femoral vein puncture for pulmonary vein isolation (PVI).
Methods
Consecutive patients referred for PVI were prospectively enrolled. Prior to right femoral vein puncture, all subjects underwent vascular ultrasound with colour Doppler imaging to identify any vessel overlying the FV exhibiting an arterial flow pattern. A segment with an arterial pulse waveform and a diameter exceeding 2.5 mm was classified as a relevant superficial corona mortis artery. The puncture site selection strategy and the incidence of post-procedural inguinal haematoma were documented.
Results
Femoral vein punctures were performed in 20 PVI procedures (14 [70%] female; mean age 65 ± 5 years; mean body mass index 30 ± 5 kg/m²). The incidence of a variant, arterial corona mortis crossing the femoral triangle was 35% (7/20). In relation to the artery’s course, puncture was performed proximally in 4 cases (57%) and distally in 3 cases (43%). Contralateral venous access was not required in any case. All patients were receiving direct oral anticoagulant therapy, and no heparin reversal was performed post-procedure. A single inguinal haematoma occurred (associated with distal puncture in the presence of the artery), none requiring surgical intervention. No major vascular complications were observed.
Conclusions
The presence of variant arterial corona mortis with potential relevance for invasive electrophysiological procedures is not uncommon. Doppler ultrasound allows reliable in vivo identification of this vessel at frequencies comparable to those reported in anatomical studies. This simple, rapid imaging technique may enable pre-procedural screening to optimise venous access strategy and minimise puncture-related complications.