Postoperative outcomes of ligasure use during common femoral artery exposure

Seroma formation after common femoral artery (CFA) exposure is a recognized complication in vascular surgery, associated with delayed wound healing and graft-related morbidity. Reported seroma rates following CFA exposure using standard electrocautery range from 5% to 15% for cases requiring operative reintervention. The LigaSure bipolar vessel sealing system has demonstrated efficacy in sealing lymphatic channels in other surgical specialties, but its safety and impact in vascular groin surgery have not been well-characterized. We evaluated the safety, feasibility, and postoperative outcomes associated with LigaSure use during CFA exposure.

We conducted a retrospective cohort study of consecutive patients undergoing open CFA exposure using LigaSure at a tertiary vascular referral center between June 2023 and November 2025, excluding any trauma cases. Demographic, clinical, operative, and postoperative outcome data were abstracted from the electronic medical record. The primary outcome was postoperative seroma formation, with clinical significance defined as the need for procedural or operative reintervention. Secondary outcomes included hematoma, surgical site infection, and fat necrosis. Observed outcome rates were descriptively compared with historically reported seroma rates after femoral artery exposure. Postoperative follow-up occurred during the index hospitalization and at scheduled outpatient visits.

Twenty-eight patients were included. Cardiovascular comorbidities were prevalent: hypertension (86%), hyperlipidemia (75%), and diabetes (50%). Four patients (14.3%; 95% confidence interval [CI], 4.03%-32.67%) developed postoperative fluid collections: two seromas (7.1%; 95% CI, 0.88%-23.50%) and two hematomas (7.1%; 95% CI, 0.88%-23.50%), comparable with historically reported seroma rates of 5% to 15% after standard electrocautery. Critically, no patients required procedural drainage, operative reintervention, or graft excision, and no graft infections or fat necrosis were observed. Only one case of skin infection and one case of skin necrosis were noted. All fluid collections resolved with conservative management, yielding a final rate of 0% for seroma requiring operative reintervention.

LigaSure use during CFA exposure was safe and feasible, with postoperative seroma rates comparable with those historically reported for standard electrocautery. Notably, 0% of seromas required procedural or operative reintervention, an important clinical consideration given the morbidity often associated with groin seromas in vascular surgery. Although a decrease in seroma incidence was not observed relative to historical benchmarks, the favorable safety profile and absence of clinically significant lymphatic complications requiring operative reintervention support LigaSure as a reliable adjunct for groin dissection. Larger prospective comparative studies are needed to further define its impact on clinically meaningful groin wound outcomes.