Transverse Versus Longitudinal Incisions for the Exposure of the Femoral Artery in Treating Patients With Peripheral Vascular Disease

Abstract

Methods: A consecutive 123 patients who survived proximal AAD surgery were reviewed at a single institution. The medical charts and computed tomography (CT) studies of these patients were reviewed from 2005 to 2014. The short axis area of the true lumen (TL), the false lumen (FL), and the total cross-sectional area were measured from reconstructed images using centerline technique at the largest segment each of the aortic arch, descending thoracic aorta (TA), aorta proximal to the celiac artery, and abdominal aorta. Survival and time to first reoperation were analyzed with Kaplan-Meier and Cox proportional hazards models. Factors associated with radiologic change were evaluated using multiple linear regression models. A significant change was defined as >10% change from the baseline CT angiogram. Results: Mean interval (baseline and the comparison CT scan) was 779 days. At least one sequential CT scan was available for 67 (55%) of the 123 patients (43 male, 34 female; mean age, 59.6 years). In general, the TA and FL increased in size during the study period (Fig; blue, TA; red, FL). Multivariate analysis showed that age >60 years and smoking were significantly associated with an increase in TL over time, whereas coronary artery disease and chronic obstructive pulmonary disease were associated with a decrease in TL (P ¼ .03). Hyperlipidemia and coronary artery disease were associated with an increase in FL size. Pre-existing aortic aneurysm, coronary surgery, and hemodialysis were significant risk factors for reoperations (P ¼ .029). Age >60 years (P ¼ .01), chronic obstructive pulmonary disease (P ¼ .002), and male gender (P ¼ .02) were also associated with an increase in total area, signifying distal aneurysmal progression. Conclusions: Patient risk factors predict unfavorable long-term morphologic outcomes in the remaining aortic tree after AAD surgical repair. These factors should be used as markers to identify patients who may benefit from closer surveillance and possibly earlier endovascular intervention to the distal TA.

Factors Associated with Wound Complications after Open Femoral Artery Exposure for Elective Endovascular Abdominal Aortic Aneurysm Repair

“…The rate of wound complications after groin incision for femoral endarterectomy and lower extremity revascularization is reported to be as high as 30 to 40% in vascular surgery patients. [7][8][9] Wound complications including infection, lymphoceles, and dehiscence are associated with prolonged hospital length of stay (LOS) and higher resource utilization. 9 More recently, total percutaneous technique without surgical incisions is being increasingly used in EVAR.…”

Longitudinal versus transverse incision for common femoral artery exposure: a systematic review and meta‐analysis

“…Seven studies were included, which involved a total of 5922 groin incisions (1951 longitudinal, 3971 transverse) in 5659 patients (Table 1). 3,7,9–13 Five studies were case‐controlled studies, 7,9,10,12,13 and two studies were randomized controlled trials 3,11 . Six studies were performed in a single institution, 3,7,10–13 whereas a single study reviewed outcomes from the Vascular Quality Initiative (VQI) database 9 .…”

“… 3,7,9–13 Five studies were case‐controlled studies, 7,9,10,12,13 and two studies were randomized controlled trials 3,11 . Six studies were performed in a single institution, 3,7,10–13 whereas a single study reviewed outcomes from the Vascular Quality Initiative (VQI) database 9 . The VQI database contains demographic, clinical, procedural and outcome data from a wide range of vascular procedures performed in multiple centres in the USA and Canada 18 .…”

“…Several studies have been performed to compare the use of a longitudinal or transverse incision for CFA exposure, yet there is still no consensus on which incision is superior 3,7,9–13 . In this systematic review and meta‐analysis, we aim to evaluate the use of a longitudinal versus transverse incision for CFA exposure on postoperative outcomes, such as wound infection and lymphatic complications.…”

Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review

“…Disruption of lymphatic channels during vascular surgery and failure of subsequent healing may result in persistent leakage, presenting as lymphocele or lymphocutaneous fistula, and may occur in as many as 18% of arterial interventions [6]. A variety of factors have also been identified that may predispose patients to lymphatic leak including surgical procedure and graft type, incision techniques, as well as patient demographics [3,5,7]. As a result, patients who develop postvascular dissection lymphatic leak have delayed wound healing, are at greater risk of infection and graft rejection, and spend more time in the hospital, thereby increasing the cost of care [2,5,6].…”