Abandoning Routine Drainage in Common Femoral Artery Exposure: A Prospective Study of Wound Outcomes and the Impact ofObesity.

BACKGROUND

To prospectively evaluate the safety and clinical outcomes of a no-drain approach for common femoral artery (CFA) exposure, challenging the routine use of closed suction drainage.

METHODS

This single-center, prospective, observational study (December 2023-June 2025) enrolled consecutive patients undergoing CFA exposure using a strict no-drain protocol. The primary end point was 30-day major adverse events (mortality, rehospitalization, or surgical reintervention). Secondary end points included primary patency, graded wound complications at 14 and 30 days, and multivariate predictors of wound morbidity.

RESULTS

We analyzed 151 patients (median age 67; 78.1% male; 21.2% obese), with 67.5% undergoing hybrid procedures. The 30-day major adverse event rate was 8% (n = 12), and 3-month primary patency was 97.4%. Early wound morbidity at 14 days included major dehiscence (16.5%) and superficial infection (10.6%), managed conservatively or with vacuum-assisted closure. Despite this early morbidity, major surgical reoperation for wound complications remained low at 2.6%. Multivariate analysis identified body mass index as the sole independent predictor of wound complications (adjusted odds ratio 1.14; 95% confidence interval 1.06-1.23; P < 0.001). Complication rates were similar between isolated CFA endarterectomy and hybrid procedures (21.4% vs 24.5%; P = 0.32).

CONCLUSION

A no-drain approach for CFA exposure is feasible and yields a low rate of surgical reoperation, a profile that extends even to complex hybrid procedures. Although early local wound morbidity is notable and requires proactive management, it is primarily driven by patient phenotype, specifically obesity.