Longitudinal Comparative Study Of Transverse Versus Vertical Groin Incision For Femoral Artery Exposure In Arterial Reconstructive Surgery

Objectives: Vertical groin incisions (VGI) have been used to access femoral vessels but reports allude to wound complications. We aim to compare VGI with transverse groin incision (TGI) for femoral artery exposure
Methods: From 2000-2005, 169 patients with 252 femoral artery exposures were studied. Composite-primary endpoints were early graft occlusion, superficial or deep groin wound infection, complicated Skin and soft tissue infection (cSSTI), haematoma, seroma, serous ooze, and wound dehiscence. Secondary endpoints were minor and major amputation, length of hospital stay and cost effectiveness.
Results: There were 128 TGI(50.8%) and 124 VGI(49.2%). Male: female was 2:1. Mean age 70.5years. Incisions were for Aorto-bifemoral bypass(14), embolectomy(8), EVAR(32), fem-fem crossover(78), and femoral-distal bypasses(122). Demographics and risk factor profile were not statistically different between groups.
Seroma developed in 5.5%(n=7)TGI and 13.7%(n=17)VGI [p=0.0129, 95%CI 0.0091 - 0.1592]. cSSTI rate was 3.9%(n=5) in TGI compared to 16.1%(n=20) in VGI [p=0.0006, 95% CI 0.0489 - 0.2002].
A non-significant rise in haematoma development was noted in VGI (7.3%) compared to TGI(4.7%) p=0.1943. VGI had a significantly higher rate of major amputation, 10.5%(n=13) compared to 1.6%(n=2) in TGI [p=0.0341, 95%CI 0.0311 - 0.1565]. Significantly higher graft failure rates were observed in VGI 7.3%(n=18) compared to 3.65%(n=9) in TGI [p=0.0374, 95%CI -00075-0.0824]. Mean hospital stay was shorter in TGI group with significant cost reduction.
Conclusions: Compared to VGI, TGI has a lower propensity to disruption of lymphatic vessels with less cSSTI, higher patency and lower amputation rates without compromising vessel exposure. We vouch for TGI in all groin surgeries.