Peripheral Arterial Disease

Post-Operative Information following Peripheral Bypass Surgery

1. Normal post-operative finding:

Mild pain and/or redness along incision. These symptoms should gradually improve; the leg should feel better each day. You may use Regular Strength Tylenol for incisional pain. You may take 2 tablets every four hours as needed for pain.

2. You may have mild-to-moderate swelling in the operated leg; this can be treated by lying on the bed or a recliner and elevating the leg on a few pillows so that the foot of the swollen leg is at eye level. The swollen leg needs to be elevated higher than your heart. It is okay to continue walking, but when not walking, elevate your leg if swelling occurs.

3. Your incision will be closed with staples or sutures. These will need to stay in place for 10-20 days.

4.Following your discharge from the hospital, you should call our office and make an appointment to be seen within 7-10 days.

5.If you develop excessive pain, redness, or swelling along the incision, or note drainage from the incision, you should notify your doctor’s office.

6.Your incision should be kept dry and clean until you see the doctor in the office for your first follow-up visit. You should not shower until your staples are removed. Sponge bathing is okay.

7.Your doctor does not want you to drive a motor vehicle until you are seen in the office for your first post- operative visit and he gives you permission.

8.You are to continue taking the same medications at the same dosages you were taking prior to surgery unless instructed otherwise by your doctor.

9.We encourage you to follow a low cholesterol diet, stop smoking, and maintain an average weight for your body build. These things have been shown to be associated with atherosclerosis which is build-up of plaque and cholesterol in the blood vessels that cause majority of artery blockages.

10.Walking is good for you. We encourage it daily. Just remember you will tire easily, so take it slowly at first and gradually increase your activity.

Carotid Disease Treatment

Narrowing of the carotid artery is generally caused by atherosclerosis – hardening of the arteries with plaque buildup. The affected area is usually the location in the neck where the artery splits into two branches. Your doctor will evaluate the benefits of repair by considering the risk factors involved. A “significant” narrowing of the artery is considered to be 50%, though surgery is generally not performed until the narrowing is greater than 60% or 70%. Your doctor will usually check for narrowing with a Duplex Ultrasound test. Options for repair include surgery (endarterectomy) or angioplasty/ stenting.

The stroke risk associated with surgery is 1-3%. Stenting is believed to have a slightly higher stroke risk compared to surgery at this time. These procedures are not performed to improve any current symptoms, but rather to prevent any new or recurrent events or strokes. Whether or not symptoms are present, carotid disease is associated with increased risk of stroke, though that risk is increased when symptoms are present. Symptomatic patients may face a 25% risk of stroke in 1.5 years, while the risk for asymptomatic patients may be only 2-3% per year. Many asymptomatic patients with carotid narrowing, also known as stenosis, are followed on annual basis with carotid duplex scans.

Aortic Aneurysms

Aneurysms are enlargements in arteries. Though they are most common in the abdominal aorta, they can occur in many other arteries, including those in the leg. When aneurysms are sufficiently large, they may require repair to prevent rupture, though repair in the legs is performed primarily to prevent clotting. As rupture is associated with a high-risk of death, repair is a frequently indicated procedure. It can be performed as an open operation with an abdominal incision, or with the placement of an endograft. An endograft operation, though not an open abdominal procedure, does require a small incision in one or both groins. Each method has its pros and cons.

Post-Operative Information following Carotid Endarterectomy

Normal post-operative findings:

Mild swelling; may feel like a hard knot along incision

Area of numbness around your incision; may involve the ear, neck, and part of the face. If you have incisional pain, you may use Tylenol. You may take up to 2 tablets every four hours as needed for pain.
If at any time following your surgery you have symptoms of a stroke or slight stroke, such as an episode of blindness in on eye, slurred speech, numbness, or weakness in an arm or leg, you should notify your doctor immediately.
Following discharge from the hospital, you should call your doctor’s office and make an appointment to be seen in the office within 7-10 days.
Your doctor does not want you to drive a motor vehicle until after you have been seen in the office and he gives you permission.
Your incision should be kept dry and clean until you are seen for your first post-operative office visit.
Dissolvable sutures were used to close your incision. These will dissolve on their own and do not have to be removed by your doctor.
You are to continue taking the same medication at the same dosages you were taking prior to surgery unless instructed otherwise by your doctor.
Walking is good for you. We encourage it daily. Just remember you will tire easily, so take it slowly at first and gradually increase your activity.

Post-Operative Infomration following Abdominal Aortic Aneurysm Repair

Normal post-operative findings:

Mild pain and/or redness along incision. These symptoms should gradually improve. You may use Regular

Strength Tylenol for incisional pain. You may take 2 tablets every four hours as needed for pain.
Your appetite will probably not be up to par for several days, and perhaps even a few weeks; this is not unusual and your appetite will improve gradually
Your incision will be closed with staples or sutures. These will remain in place for 10-20 days. They may be removed before you discharge from the hospital but, if not, they will be removed in our office at your first post-operative visit. You may shower once all the staples are removed; until they are removed, sponge bathing is recommended.
Following your discharge from the hospital, you should call our office and make an appointment to be seen within 7-10 days.
Your doctor does not want you to drive a motor vehicle until you are seen in the office for your first post-operative visit and he gives your permission.
It is important that you avoid lifting after you’re discharged. The abdominal muscles need up to three months to completely heal. Have someone help you by taking out the garbage, carrying groceries, etc., until you are completely healed.
Walking is good for you. We encourage it daily. Just remember you will tire easily, so take it slowly at first and gradually increase your distance.
You are to continue taking the same medications at the same dosages you were taking prior to surgery unless instructed otherwise by your doctor.
We encourage you to follow a low cholesterol diet, stop smoking, and maintain an average weight for your body build.

What to expect with the operation:

You will generally be admitted to the hospital on the day of your surgery. Stopping your aspirin therapy before the operation is not necessary. A choice of anesthesia – either general or a cervical (neck) block – is provided. Following the operation, most patients spend the night in the ICU as a precaution, so that blood pressure and pulse may be observed. The operation is generally not associated with severe pain. Generally, Tylenol is sufficient once a patient has returned home.

Surgery vs. Endograft

Open Surgery Pros

Established track record, with excellent long-term results.
Generally requires few or no follow-ups. Allows more options with various types of aneurysms.
Very little long-term risk of rupture after repair.

Open Surgery Cons

Requires longer hospital post-op stay (about 5-7 days).
Associated with longer post-op recovery period. Slightly higher risk of operative complications (2-5%).

Endograft Pros

Quicker recovery and shorter hospital stay than with open surgery. (2-3 days)
Lower operative risk.

Endograft Cons

Requires lifelong Ultrasound or CT Scan followup at least yearly.
Small incidence of late rupture.
Some aneurysms are anatomically unsuitable for endograft treatment.

Important Post-operative Cautions

Blood pressure must be self-monitored at home, and a home blood pressure cuff is advised. If any severe elevation is observed, contact your doctor immediately.

Exercise your neck with range of motion exercises to prevent stiffness.
Wait 48 hours after surgery to shower, and be sure to keep wound clean and dry otherwise.
Resume your medications, including aspirin, following surgery.

Post-Operative Information following Dialysis-Access Surgery

It is normal to have mild redness, swelling, and/or pain around the incision site. These symptoms will gradually improve each day. If there is no gradual improvement, or if you notice extensive pain and swelling or drainage, you should call our office.
Incision staples should remain in place for 10-20 days following the surgery. If you go home from the hospital with your staples in, you will usually have them removed at dialysis, but you can also call and make an appointment for staple removal at our office.
Your incision should be kept dry and clean until the staples are removed.
You are to continue taking the same medication at the same dosages you were taking prior to surgery unless instructed otherwise by your doctor.