Five Years' Experience of Transverse Groin Incision for Femoral Artery Access in Arterial Reconstructive Surgery: Parallel Observational Longitudinal Group Comparison Study

Abstract

Vertical groin incisions (VGIs) have been used to access femoral vessels, but reports allude to wound complications. Our aim was to compare VGI with transverse groin incision (TGI) for femoral artery exposure. Over a 5-year interval, 196 patients with 284 femoral artery exposures for supra- and infrainguinal procedures were studied. Primary endpoints were surgical skin site wound infection, seroma, haematoma formation, and major lower limb amputation. Secondary endpoints were graft patency, wound paresthesias, and length of hospital stay. There were 160 TGIs and 124 VGIs. The demographics and risk factor profile were not statistically different between groups. Seroma developed in 4.4% of TGIs and 13.7% of VGIs (p= .005). The complicated skin and soft tissue infection rate was five times greater with VGI (p= .001). The VGI group had a significantly higher rate of major amputation (p= .0005). Significantly higher graft failure rates were observed in the VGI group (p= .011). No paresthesia was reported in any TGI wound. The mean hospital stay was also significantly shorter in the TGI group (p= .006). The study data support and expound on the theory that an alternative incision to VGI offers lower short- and long-term morbidity. Our findings sustain the selection of the TGI in femoral artery surgery for both supra- and infrainguinal procedures without compromise of vessel exposure.

Surgical wound infections after peripheral vascular surgery

“…Many surgeons prefer a vertical incision because it offers a direct approach and full exposure of the femoral artery. Two retrospective studies (n = 149, n = 196) have revealed that oblique groin incision for vascular access significantly decreased the incidence of SWI compared with vertical incision (4, 34). However, a later study using prospective collected data (n = 171) showed no difference between the two incisions (8).…”

Utility of Electrofusion for the Femoral Approach in Vascular Surgery: A Randomized Prospective Study

“…This result is comparable with the 3.5e7.6% rates reported in the literature. 5,11,26,28,30 Cutaneous disunions were observed in 14% of the electrofusion approaches and 15.3% of the conventional approaches (P ¼ 0.751). These observations are comparable with the results of Kent et al 28 and Swinnen et al 1 (3.8% and 30% of disunion).…”

“…10 Concerning the surgical technique, a transverse rather than a longitudinal approach to the femoral arteries reduces the risk of infections and lymphatic complications. 11 New technology such as electrofusion was tested, in particular in senology, where electrofusion showed its superiority in terms of reduction in the durations of drainage, 12,13 hospitalization, 13 and seromas 14 in axillary lymph node dissection.…”

Antibiotic Prophylaxis With Trimethoprim/Sulfamethoxazole Instead of Cloxacillin/Cefotaxime Increases Inguinal Surgical Site Infection Rate After Lower Extremity Revascularization

“…5 The relationship between antibiotic prophylaxis and SSI thus seems to extend beyond a simple antibiotic-microbe interaction. It is well known that SSIs carry a multitude of etiologies and reducing the risk of SSI is not only associated with appropriate systemic antibiotic prophylaxis but foremost meticulous surgical site preparation and surgical technique 19 to minimize the 20 glucose control, 21 preoperative hair removal, 22 surgical incision 23 and dissection 24 technique, laminar and non-laminar airflow in operating room ventilation systems, 25 implantation of silver grafts, 26 utilization of triclosan-coated sutures, 27,28 and local application of antibiotics. 29 The limitations of this study might be attributed to a statistical type 2 error.…”