Temporal stability of femoral artery access localization in repeated digital subtraction angiography: clinical determinants and anatomical variability

Aim: To evaluate the temporal stability of femoral artery access-site localization in patients undergoing repeated digital subtraction angiography (DSA) and to identify independent anatomical and procedural factors associated with instability in localization.Methods: This retrospective analytical study included 161 patients who underwent femoral artery access on multiple occasions for DSA or neurointerventional procedures between December 2020 and December 2024. Only patients who underwent repeated ipsilateral femoral access were included in the primary temporal stability analysis to avoid anatomical variation between limbs. Femoral artery puncture sites were fluoroscopically classified as being located over or outside the femoral head. Punctures outside the femoral head were further categorized as high or low punctures. Multivariable logistic regression was used to identify independent predictors of localization instability.Results: The mean age was 56.25±14.42 years, and 54.2% of patients were male. The proportion of punctures located over the femoral head decreased from 78.9% during the initial access to 71.4% during repeat access. The proportion of punctures outside the femoral head increased from 21.1% to 28.6%, although this paired within-patient difference was not statistically significant. On multivariable analysis, BMI ≥25 kg/m², high femoral bifurcation, femoral artery calcification, increased skin-to-artery depth, smaller common femoral artery diameter, and absence of ultrasound guidance were independently associated with localization instability.Conclusion: Femoral artery access-site localization may vary across repeated DSA and endovascular procedures, even when ipsilateral access is used. Patient-specific reassessment of femoral anatomy and ultrasound-guided puncture may improve the reproducibility of access-site localization and procedural safety.