The impact of surgical access to the femoral artery on incidence of wound complications following vascular procedures, with regard to lymphatic complications

Abstract

Background. Groin surgical wounds are the commonest sites of infection in peripheral vascular surgery. Disruption of the groin lymphatic network during preparation of femoral artery may be one of the factors that increase the risk of infection.
Aim of the study. The aim of the study was to find whether damage to the groin lymphatic system associated with infection focus in the distal part of the operated extremity influenced the risk of contamination of the surgical wound, and whether lateral access to the femoral artery decreased the rate of lymphatic complication after reconstructive vascular surgery.
Material and methods. The trial has been designed as a prospective and randomised study. Bacteriological studies were performed on 25 patients, the samples were harvested from the necrotic tissues and enlarged lymph nodes within the operated extremity.
Prevalence of lymphatic complications was evaluated basing on analysis of healing of 57 wounds after adoption of lateral access to the femoral artery and 55 wounds after adoption of direct access to the femoral artery. Lymphoscintigraphic studies were performed on 10 and 12 lower extremities, respectively.
Results. Positive cultures with the same organism present in both necrosis and lymph node were found in 6/25 cases. Lymphatic complications in the form of lymphatic fistula occurred in one case after adoption of direct access to the femoral artery, and lymphocele occurred in one case in each group. The lymphoceles were diagnosed only by means of lymphoscintigraphy.
Conclusions. Disruption of groin lymph nodes carries the significant risk of transferring the infection from the distal parts of the operated extremity to the groin. Lateral access to the femoral artery in reconstructive vascular surgery does not prevent the development of groin lymphatic complications.