Transverse versus vertical groin incision for femoral artery approach

Cochrane Library Canteras

Marcus Canteras; Jose CC Baptista‐Silva; Frederico do Carmo Novaes; Daniel G Cacione

 

Background

Access to the femoral vessels is necessary for a wide range of vascular procedures, including treatment of thromboembolic disease, arterial grafts, endovascular repair of abdominal aortic aneurysm, thoracic endovascular aneurysm repair and transcatheter aortic valve implantation. The surgical technique used to access the femoral artery may be a factor in the occurrence of postoperative complications; this is the focus of our review.

We compared the transverse surgical technique (a cut made parallel to the groin crease) versus the vertical groin incision at the inguinal region (classic surgical technique: a cut made across the groin crease) to access the femoral artery, in an attempt to determine which technique has the lower rate of complications, is safer and is more effective.

Study characteristics and key results

This systematic review includes two studies (most recent search February 2020): one randomized controlled trial and one quasi‐randomized clinical trial. Both compared transverse versus vertical inguinal approaches. One study included 149 participants (167 groins) while the second study included 88 participants (116 groins), undergoing inguinal surgery to access the femoral artery.

The outcome 'wound or surgical site infection' was assessed in both studies. The combined analysis showed a lower rate of wound infections for the transverse inguinal incision compared with the vertical inguinal incision. One study assessed lymphatic complications and found no evidence of a difference between the two incision techniques. Other outcomes such as infection of the graft, hospitalization, death and postoperative pain were not reported by the two studies

Certainty of the evidence

We classified the certainty of the evidence as low for surgical site infection due to the high risk of bias because of issues with randomization and the blinding of people assessing the outcomes and the small number of participants in included studies. We considered the lymphatic complications of very low certainty evidence due to the high risk of bias because of issues with randomization and the blinding of people assessing the outcomes, and because there was only one included study with a small number of participants assessing lymphatic complications.

Conclusion

Evidence of low certainty suggests that surgical wound infection in the 28‐day period post surgery occurs less frequently in transverse incisions than in vertical incisions to access the femoral artery. Evidence of very‐low certainty indicated that there was no evidence of a difference between the two surgical techniques relating to the lymphatic complications' outcome for access to the femoral artery in the 28‐day period post surgery.

 

 

 

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