Femoral Sheath

vagina femoralis

The femoral sheath is a funnel-shaped fascial sleeve below the inguinal ligament formed by extensions of the transversalis fascia (anterior wall) and the iliacus fascia (posterior wall). It encloses the femoral artery and vein in two lateral compartments and is divided into three sections: the lateral compartment (femoral artery), the intermediate compartment (femoral vein), and the medial compartment (femoral canal). The femoral nerve lies lateral to and outside the sheath.

Region: Thigh

Clinical Relevance

Clinical Notes

The femoral sheath is the fascial compartment accessed for common femoral artery and vein cannulation. The sheath is opened to access the vessels for ECMO, IABP, arteriovenous access for dialysis, and cardiac catheterisation. In vascular surgery, the femoral sheath is opened for femoral endarterectomy, bypass anastomosis, and femoral artery aneurysm repair. The sheath is encountered during femoral hernia repair as the medial compartment (femoral canal) is the hernia passage.

Pathology

Common Injuries & Conditions

Femoral Sheath Haematoma from Vascular Access

Bleeding from inadequately sealed femoral arterial access accumulates within the femoral sheath, producing a contained haematoma that compresses the femoral vein causing leg swelling, or may track proximally to the retroperitoneum if the sheath is disrupted; managed by direct pressure, ultrasound-guided thrombin injection for pseudoaneurysm, or surgical control.