Surgical repair of femoral artery access complications: a comparison of hemorrhagic and occlusive injuries.

OBJECTIVES: To evaluate outcomes following surgical repair of common femoral artery (CFA) access complications and compare hemorrhagic and occlusive injuries. METHODS: We conducted a retrospective single-center study of all patients undergoing surgical CFA repair for access complications between 2010 and 2025, classified as hemorrhagic or occlusive injuries. Demographics, comorbidities, procedural characteristics, and postoperative outcomes were collected from electronic medical records. The primary outcome was 90-day groin wound surgical site infection (SSI) according to Centers for Disease Control and Prevention (CDC) criteria. Secondary outcomes included other wound complications, ipsilateral amputation, length of stay, readmission, and mortality. RESULTS: Among 172 patients undergoing surgical CFA repair, 100 (58.1%) had hemorrhagic and 72 (41.9%) occlusive injuries. Among 149 patients with available follow-up, 42.3% developed a groin wound complication and 28.2% developed a CDC-defined infection. Infection rates were significantly higher following hemorrhagic compared with occlusive injury (34.9% vs 19.7%; P = .040). In univariable analysis, BMI ≥30, diabetes mellitus, congestive heart failure, synthetic versus bovine patch use, and therapeutic anticoagulation were significantly associated with 90-day SSI according to CDC criteria, while hemorrhagic access repair showed a borderline significant association and closed-incision negative pressure wound therapy appeared protective. In multivariable analysis, hemorrhagic injury and BMI ≥30 were independently associated with 90-day SSI of the groin. CONCLUSIONS: Surgical repair of CFA access complications is associated with substantial postoperative morbidity, particularly wound infection. Hemorrhagic injuries represent a high-risk subgroup and should be considered distinct from occlusive injuries, warranting tailored treatment and preventive strategies.