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Transverse versus Longitudinal Groin Re-Exposure to Manage Recurrent Peripheral Artery Disease
Punam P. Parikh, MD, Gustavo Rubio, MD, Kunal P. Patel, BS, Karan Gupta, BS, Keith Jones, MD, Jorge Rey, MD, Handel Robinson, MD.
University of Miami, Miami, FL, USA.

Introduction:  Access to femoral vessels for peripheral artery disease (PAD) management may be done through a transverse or longitudinal groin incision. Longitudinal incisions may allow superior vessel exposure but higher wound complication rate than transverse incisions. Wound complication rate of transverse vs longitudinal groin incision for femoral vessel exposure in patients requiring reoperation for PAD is currently unknown. The purpose of this study was to determine wound complication rate in vasculopaths undergoing reoperation through a transverse or longitudinal incision for recurrent PAD management. 
Methods:  A retrospective review of patients undergoing lower extremity revascularizations from 2013-2015 was conducted. Forty-five patients undergoing a total of 51 lower extremity revascularizations requiring redo groin incision for femoral artery exposure were identified. Data were reviewed for transverse and longitudinal groin incisions in patients undergoing repeat common or iliofemoral endarterectomies, or where the femoral artery was used as an inflow and/or outflow vessel for redo limb revascularizations. Wound complications (infection, lymphocele, hematoma, dehiscence or necrosis) were compared between groups. Data were analyzed using two-tailed chi-square and student's t-test.
Results: Overall, 19 patients (37%) underwent a transverse groin exposure vs 32 patients (63%) who underwent longitudinal groin exposure for reoperative PAD. There was no significant difference in demographics including age, gender, history of hypertension, hyperlipidemia, myocardial infarction, diabetes, smoking, anticoagulation, anti-platelet or immunosuppressive therapy between groups. Median follow-up was 4 months for either group. There was a significantly lower rate of wound complications in patients undergoing redo groin exposure through a transverse approach (16% vs 44%, p<0.05). Specifically, transverse groin exposure had lower rates of surgical site infection (5% vs 16%), lymphocele (0% vs 3%), hematoma (5% vs 6%) and wound dehiscence (0% vs 16%) than longitudinal groin exposure. Wound complications resulting from longitudinal incisions also had a higher rate of return-to-OR compared to transverse incision group (22% vs 11%). 
Conclusion: Reoperation through a transverse incision for femoral vessel exposure during recurrent PAD offers a significantly lower rate of wound infection when compared to a longitudinal approach.  Patients in the former group may also experience a lower rate of return-to-OR for the management of wound complications. This should be added to the repertoire of the vascular surgeon with usage based on anatomical circumstance and pattern of disease being treated. 


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