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Utility of electrofusion for the femoral approach in vascular surgery: a randomized prospective study
Flora Gouaillier-Vulcain1, Etienne Marchand1, Robert Martinez1
1Service de Chirurgie Vasculaire, Hôpital Trousseau, Tours, France.
Insights
Electrofusion reduced local complications and seromas in femoral vascular surgery but did not significantly improve overall wound healing rates at one month. Further research is needed to optimize its application.
Area of Science:
- Vascular Surgery
- Surgical Techniques
- Wound Healing
Background:
- Local complications frequently occur after femoral artery surgery, delaying wound healing.
- Electrofusion has shown promise in reducing complications in general surgery.
- Its efficacy in vascular surgery, specifically femoral approaches, remained unevaluated.
Purpose of the Study:
- To assess if electrofusion improves femoral vessel approach healing at one month.
- To determine if electrofusion reduces local complications compared to conventional methods.
- To investigate the impact of electrofusion on cutaneous, infectious, and lymphatic complications.
Main Methods:
- Prospective randomized study in two French teaching hospitals (May 2012-April 2013).
- Included patients requiring surgical access of the femoral trigone.
- Compared electrofusion against conventional techniques (diathermy or cold scalpel) for femoral artery exposure.
Main Results:
- 86.3% of all approaches healed at one month, with no significant difference between groups (88.5% electrofusion vs. 84% conventional).
- Electrofusion group showed significantly fewer local complications (P=0.012) and seromas (P=0.012).
- Reduced drainage quantities and durations were observed with electrofusion, potentially linked to fewer complications.
Conclusions:
- Electrofusion use in femoral approaches decreased lymphatic complications.
- This reduction in a single parameter was insufficient to enhance overall healing rates at one month.
- Electrofusion may offer benefits in managing specific complications post-femoral surgery.
Background:
The local complications are frequent after a femoral approach in vascular surgery and are often the cause of a delay in healing. Electrofusion showed its effectiveness to decrease the complications in general surgery but was not tested in vascular surgery. The aim of our study was to evaluate if the use of electrofusion in the approach to femoral vessels improved healing at 1 month by decreasing the local complications.
Methods:
This prospective randomized study was conducted in 2 centers from May 1, 2012 to April 30, 2013. All the patients requiring a surgical access of the femoral trigone were included in 2 French teaching hospitals. Femoral artery surgical exposure was carried out using electrofusion or according to the conventional technique (diathermy or cold scalpel) according to a protocol of randomization. The principle criterion of the study was a complete healing at 1 month. The secondary criteria were the appearance of cutaneous, infectious, or lymphatic local complications.
Results:
Two hundred ninety-two femoral approaches were carried out in 221 consecutive patients. One hundred forty-eight approaches were carried out with electrofusion and 144 according to the conventional technique. The demographic and operative characteristics were similar between the 2 groups. At 1 month, 86.3% of the approaches were healed without statistically significant difference between the 2 groups (88.5% vs. 84%, P = 0.241). There were less local complications (P = 0.012) and seromas (P = 0.012) in the electrofusion group. This difference could be linked with the least quantities (P = 0.036) and durations (P = 0.014) of drainage observed after approaches carried out with electrofusion. On the other hand, the incidence of cutaneous or infectious complications was not different between the 2 groups.
Conclusions:
In our series, the use of electrofusion decreased the lymphatic complications after a femoral approach. However, the correction of this single parameter was not sufficient to improve the rate of healing at 1 month.
