Initial Experience with HARMONIC FOCUS® Inguinal Exposure in Endovascular Aortic Aneurysm Repair

Abstract

An inguinal exposure provides adequate access to the femoral vessels, but with it comes risk of wound complications. Ultrasonic shears and blades have been shown to decrease complications in other anatomic dissections. There remains a paucity of literature on the usage of ultrasonic harmonic dissection techniques in the vascular surgery realm. This study depicts the initial experience using HARMONIC FOCUS(®) (HF) for inguinal exposure in both endovascular abdominal aortic aneurysm repair (EVAR) and thoracic endovascular abdominal aortic aneurysm repair (TEVAR) operations. Patients who underwent an EVAR or a TEVAR operation with an open inguinal exposure during an 11-month period were included. Over the study period, 30 patients underwent an endovascular aortic aneurysm repair with open inguinal exposure; 25 patients had an EVAR and 5 patients underwent a TEVAR. Conventional electrocautery was used in 32 inguinal exposures and HF was used in 28. Six inguinal wounds developed postoperative complications in the study (10%). These occurred in 5 patients over a 4-month follow-up period. Conventional electrocautery dissection was used in 5 of the wounds (15.6%) and ultrasonic harmonic scalpel was used in 1 (3.6%). The complications consisted of 3 lymphocutaneous fistulas, 1 wound infection and 2 lymphoceles without fistula formation. We present the initial experience of HF dissection in inguinal exposure in a small population of patients who underwent EVAR and TEVAR. In this study, we demonstrate this technique may be associated with a lower incidence of postoperative wound complications when compared with conventional electrocautery inguinal exposure.