Background The femoral circumflex arteries (FCAs), arising from the femoral and profunda femoris arterial system, exhibit substantial anatomical variability and are clinically relevant due to their role in supplying the femoral head and proximal thigh musculature. These variations may affect surgical, vascular, reconstructive, and anesthetic procedures in the femoral region. The objective of this study is to systematically evaluate the prevalence of FCA anatomical variants, characterize their patterns, and assess their clinical and surgical implications. Methods A systematic search was performed across PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS up to July 2025. Studies describing morphological or branching variants of the medial or lateral FCA were included. Methodological quality was assessed using the Anatomical Quality Assurance tool. A random-effects model estimated pooled prevalences and subgroup differences. Thirty-six studies met the eligibility criteria, of which 29 contributed data to the quantitative meta-analysis. Results The global pooled prevalence of FCA variations was 56% (95% confidence interval [CI]: 46%–66%) with high heterogeneity (I2 = 99.5%). No significant laterality predominance was observed. Regional subgroup analysis demonstrated higher prevalence in European populations (33%, 95% CI: 25%–42%) relative to Asian populations (28%, 95% CI: 20%–36%). Sex-specific analysis showed a greater prevalence in females (72%, 95% CI: 59%–84%) than in males (42%, 95% CI: 29%–54%). Variations primarily involved origin, branching pattern, and course of the FCAs. Conclusion Anatomical variations of the FCAs are common and exhibit significant geographic and sexual variability. Based on this, we have proposed a classification of the probability of iatrogenic injury according to FCA variant and its relationship to the main surgical approaches to the hip.
Background While carotid revascularization reduces stroke risk in both asymptomatic (AD) and symptomatic (SD) carotid diseases, its role continues to evolve with advances in medical therapy, surgical techniques, and cost considerations. Methods This retrospective study reviews outcomes of patients undergoing revascularization at a level 1 stroke center between 2019 and 2024. Primary endpoints were ipsilateral stroke, myocardial infarction (MI), and death at 30 days, 90 days, and 1 year. Secondary endpoints include restenosis rates. Results A total of 113 patients underwent 127 carotid endarterectomies. Sixty-four percent presented with SD, with a median time to intervention of 9 days (interquartile range 6–11). Patients with SD had a longer median length of stay (2 vs. 1 day, P = 0.076. Follow-up rates were higher in AD at 1 year (65% vs. 36%, P = 0.003). MI rates were 0% at 30 days and 90 days and 0.9% at 1 year. Stroke rates were 0.9%, 0.9%, and 1.8% at 30 days, 90 days, and 1 year, with no difference between AD versus SD. One-year mortality rates were 0.9% and 5.3% at 90 days and 1 year, without a difference by AD versus SD. Restenosis occurred in 4% of patients, with no difference between groups. Conclusion Carotid endarterectomy was associated with low perioperative rates of ipsilateral stroke, MI, and death. Despite a longer length of stay, patients with SD did not have significantly different outcomes or restenosis rates. While males had improved follow-up rates, there was no significant difference in outcomes by gender or race. These findings support favorable outcomes following CEA in both AD and SD.
