Positional effects on femoral vein cross-sectional area: a prospective ultrasonographic study

Yıl 2025, Cilt: 7 Sayı: 4, 529 - 534, 28.07.2025

İhsaniye Süer Doğan , Nezih Kavak

https://doi.org/10.38053/acmj.1709927

Öz

Aims: The study aimed to assess the variation in femoral vein diameter and cross-sectional area (CSA) across different body positions in a cohort of healthy Turkish adults and to explore the associations between venous measurements and demographic variables, including age, sex, and body-mass index (BMI).
Methods: Ultrasonographic measurements of the right and left femoral vein diameters and CSA were obtained in five distinct body positions from 278 healthy adults, encompassing a total of 556 lower limbs. Demographic parameters, including age, sex, and BMI, were systematically documented for each participant.
Results: A total of 278 participants (556 limbs) were analysed. Males exhibited significantly higher femoral vein CSA than females across all positions (p<0.001). The lowest mean CSA was in the Trendelenburg position (0.87±0.08 cm²), and the highest in the reverse Trendelenburg+frog-leg position (1.51±0.11 cm²) (p<0.001). CSA positively correlated with age in all positions except Trendelenburg (r=0.400–0.479, p<0.001). Overweight and obese (class I) individuals showed significantly higher CSA values than normal or underweight participants (p<0.001).
Conclusion: This study demonstrates that body positioning significantly affects the CSA of the femoral vein. Additionally, factors such as age, sex, and BMI were found to significantly influence femoral vein calibre.

Anahtar Kelimeler

Femoral vein , cross-sectional area , ultrasonography

Kaynakça

• Woodfall K, van Zundert A. Central Venous access: an update on modern techniques to avoid complications. Healthcare (Basel). 2025;13(10):1168. doi:10.3390/healthcare13101168
• Kolikof J, Peterson K, Williams C, et al. Central venous catheter insertion. [Updated 2025 Feb 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557798/
• Echefu G, Stowe I, Lukan A, et al. Central vein stenosis in hemodialysis vascular access: clinical manifestations and contemporary management strategies. Front Nephrol. 2023;3:1280666. doi:10.3389/fneph.2023. 1280666
• Boulet N, Muller L, Rickard CM, Lefrant JY, Roger C. How to improve the efficiency and the safety of real-time ultrasound-guided central venous catheterization in 2023: a narrative review. Ann Intensive Care. 2023;13(1):117. doi:10.1186/s13613-023-01212-y
• Misirlioglu M, Yildizdas D, Yavas et al. Central venous catheter insertion for vascular access: a 6-year single-center experience. Indian J Crit Care Med. 2023;27(10):748-753. doi:10.5005/jp-journals-10071-24536
• Lockwood J, Desai N. Central venous access. Br J Hosp Med (Lond). 2019;80(8):C114. doi:10.12968/hmed.2019.80.8.C114
• Abdulelah M, Haider O, Abdulelah H, Jamouss KT, Higgins TL. Venous access devices (Review). Med Int (Lond). 2025;5(4):42. doi:10.3892/mi. 2025.241
• Tsotsolis N, Tsirgogianni K, Kioumis I, et al. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med. 2015;3(3):40. doi:10.3978/j.issn.2305-5839.2015.02.11
• Sakuraya M, Okano H, Yoshihiro S, Niida S, Kimura K. Insertion site of central venous catheter among hospitalized adult patients: a systematic review and network meta-analysis. Front Med (Lausanne). 2022;9: 960135. doi:10.3389/fmed.2022.960135
• Annetta MG, Elli S, Marche B, Pinelli F, Pittiruti M. Femoral venous access: state of the art and future perspectives. J Vasc Access. 2025;26(2): 361-371. doi:10.1177/11297298231209253
• Vezzani A, Manca T, Vercelli A, Braghieri A, Magnacavallo A. Ultrasonography as a guide during vascular access procedures and in the diagnosis of complications. J Ultrasound. 2013;16(4):161-170. doi:10. 1007/s40477-013-0046-5
• Adrian M, Borgquist O, Kröger T, et al. Mechanical complications after central venous catheterisation in the ultrasound-guided era: a prospective multicentre cohort study. Br J Anaesth. 2022;129(6):843-850. doi:10.1016/j.bja.2022.08.036
• Imai E, Kataoka Y, Watanabe J, et al. Ultrasound-guided central venous catheterization around the neck: systematic review and network meta-analysis. Am J Emerg Med. 2024;78:206-214. doi:10.1016/j.ajem.2024.01.043
• Czyzewska D, Ustymowicz A, Kowalewski R, Zurada A, Krejza J. Cross-sectional area of the femoral vein varies with leg position and distance from the inguinal ligament. PLoS One. 2017;12(8):e0182623. doi:10.1371/journal.pone.0182623
• Stone MB, Price DD, Anderson BS. Ultrasonographic investigation of the effect of reverse Trendelenburg on the cross-sectional area of the femoral vein. J Emerg Med. 2006;30(2):211-213. doi:10.1016/j.jemermed. 2005.05.022
• Suk EH, Kim DH, Kil HK, Kweon TD. Effects of reverse Trendelenburg position and inguinal compression on femoral vein cross-sectional area in infants and young children. Anaesthesia. 2009;64(4):399-402. doi:10. 1111/j.1365-2044.2008.05815.x
• Kim JT, Lee NJ, Na HS, et al. Ultrasonographic investigation of the effect of inguinal compression on the cross-sectional area of the femoral vein. Acad Emerg Med. 2008;15(1):101-3. doi:10.1111/j.1553-2712.2007.00018.x
• Weir CB, Jan A. BMI classification percentile and cut off points. 2023 Jun 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
• Lee SH, Yu DU, Kim TK, et al. Analysis of the common femoral artery and vein: anatomical morphology, vessel relationship, and factors affecting vessel size. Medicina (Kaunas). 2022;58(2):325. doi:10.3390/medicina58020325
• Keiler J, Seidel R, Wree A. The femoral vein diameter and its correlation with sex, age and body mass index-an anatomical parameter with clinical relevance. Phlebology. 2019;34(1):58-69. doi:10.1177/0268355518772746
• Molnár AÁ, Nádasy GL, Dörnyei G, et al. The aging venous system: from varicosities to vascular cognitive impairment. Geroscience. 2021;43(6): 2761-2784. doi:10.1007/s11357-021-00475-2