PATIENT INFORMATION

Peripheral Arterial Disease Procedures

Procedure Instructions

Endovascular Procedures

Before the Endovascular Procedure

The procedures may take 30 minutes to several hours. You may be required to stay overnight in the hospital. Arrange for a responsible adult to drive you home.

Although you can be awake during the procedure, you will receive a local anesthetic to numb your skin at site of the puncture. You will be given fluids and medications to help you relax through an IV.

The doctor may ask you to refrain from eating or drinking after midnight on the day of your procedure, although you may be asked to take certain of your medications with a sip of water on the morning of your procedure. Be sure you inform your doctor of all medications you take.

After the Endovascular Procedure

For either procedure, you will lay flat after the procedure and may be asked not to bend your leg for 2 to 6 hours. During this time the blood flow in your legs will be closely monitored by nurses who will check your pulses and skin color and temperature. You’ll likely go home within hours of your procedure, although some patients spend the night in the hospital. Expect to have some swelling and bruising around the puncture site at the groin, and possibly spreading across your thigh and abdomen. This is normal.

Risks and complications of this procedure include rupture of the treated artery, bleeding, blood clots, heart or lung complications, and kidney problems.

When To Call the Doctor

• Bleeding at the catheter insertion (puncture) site.
• Excessive swelling.
• Chest pain or trouble breathing.
• A fever of 101.5 degrees or higher.
• A foot that gets cold to touch or turns a mottled/purple color.
• A return of symptoms similar to those you had before the procedure.

You are always welcome to call the office with your questions or concerns. After hours, an answering service will direct your questions to the on-call providers. However, these individuals are unable to call in prescriptions for pain medication after 5 p.m.

BYPASS SURGERY

Bypass surgery may be the only option for longer or more severe blockages in an artery. Bypass surgery involves using a graft to create a new pathway for blood around the blockage. The graft may be a synthetic tube or a vein from your leg or arm.

Risks and Complications of Bypass Surgery

It is important to be aware of the risks and complications before any surgical procedure. The risks and complications for bypass surgery include: bleeding, infection, numbness or pain around the incisions, risks from anesthesia, the need for an amputation or a second surgery to remove dead tissue, and blood clots.

Preparing for BYPASS Surgery

Your surgeon will tell you how to prepare for your surgery. Be sure to ask any and all questions you may have. On the day of the surgery, do your best to arrive at the hospital on time.

• Some procedures may require blood transfusions. You may choose to donate your own blood before surgery, in case it is needed.
• Stop smoking at least 3 weeks before surgery.
• You may be asked to get an EKG (electrocardiogram), chest x-ray, or blood tests.
• Tell your doctor about all medications you are taking, including vitamins, supplements, and blood thinners.
• The day before surgery, take any medications your surgeon tells you to. Don’t eat or drink anything after midnight on the day of the surgery.
• Make sure that you have someone to drive you home from the hospital when you are discharged, usually in 3 to 8 days.

Abdominal Bypass: The large artery in the abdomen is the aorta. If this gets blocked, bypass surgery may be needed. To reach the blockage, the surgeon makes a large incision along the abdomen and two incisions at each groin. A synthetic graft is then sewn into the artery above and below the blocked section. Once blood flows freely through the graft, the incision is closed with sutures or staples.

Leg Bypass: To bypass a blocked leg artery, a healthy vein from that same leg is often used for the graft. The vein may be removed through one long incision or several smaller ones. Other times a vein needs to be removed from the opposite leg or an arm. In some cases, a synthetic graft is used. If possible the surgeon will use a natural vein from one of the extremities because these veins last the longest. Once the graft is ready, the surgeon makes an incision near the damaged artery. The graft is sutured to the artery above and below the blockage. Once blood is flowing through the graft, the incision is closed with sutures or staples. The blocked section of artery is usually not removed. Peripheral bypass grafts carry blood from the femoral artery, in your thigh, to an artery further down your leg. This graft usually goes to either the popliteal artery near your knee, or to an artery in the lower leg.

Recovering from Bypass Surgery

• You will recover in the hospital for 3 to 8 days after surgery, depending on the type of bypass you have, your health, and your response to surgery. Full recovery may require a month or more.
• After surgery you will be monitored closely in the recovery room, and from there you may go to an intensive care unit or to a regular hospital room. Your abdomen and groin will swell and be painful, but your doctor will prescribe pain medications to control the pain.
• For best recovery, you should start to be active soon after surgery. Typically, on the day after surgery you will get out of bed to sit in a chair. Don’t stand or sit with your feet down for a long period of time. When you sit, raise your foot as high as you comfortably can to prevent swelling.
• About 48 hours after surgery, your nurse or physical therapist will assist you in getting up and walking. Walking is very important after surgery. Walking helps to reduce swelling, speeds healing, and helps prevent lung problems such as pneumonia. The sooner you are up and walking, the sooner you can go home. Wear slippers or shoes to protect your feet.
• Tell a nurse right away if you have chest pain, foot pain, or shortness of breath.
• Numbness and tingling in your foot is common after surgery, but tell your nurse if your foot appears mottled or purple in color or feels cold.

Constipation is very common following a surgery. The anesthetic used during the operation paralyzes the bowel, which can lead to constipation for up to a week. Pain medications such as Vicodin or Percocet also cause the bowel to move more slowly. You may try over-the-counter medications such as milk of magnesia, Colace, or Metamucil, as well as prune or apple juice to get your bowels moving.

Pain is common after surgery, especially around an incision site. The pain medication prescribed by your doctor will help with this pain, which should improve in the days following your surgery. Be sure to stay ahead of the pain and take your pain medication as prescribed. Check with your doctor before using other pain medication in addition to the prescribed pain medication.

Fever: Your temperature can vary after surgery and a low-grade temperature is common. If your temperature exceeds 101.5 degrees or if it is accompanied by chills, vomiting, or flu-like symptoms, the doctor should be notified.

Caring for Yourself after Surgery

Activity: When you are at home, remember to elevate your leg as much as possible while you are sitting. Do not stand for a prolonged period of time. You should try to walk periodically throughout the day.

Shower: You can shower 24-48 hours after surgery, unless otherwise instructed by your doctor. There will be sterile tape (called a “steri-strip”) over the incision. Leave the tape on while showering. Do not soak in a bath or hot tub. Sometimes an incision is stapled and you won’t have steri-strip. In this case you can shower without a bandage. Be sure to dry the area well afterwards.

Incision: Your incisions will be covered by a sterile bandage or steri-strip, which will fall off in time on its own or be removed by the doctor at your post-op visit. A slight drainage of thin watery fluid may occur. Report any drainage from your incision. An infection may be starting if the drainage is thick green or yellow, or if the skin around an incision is red or warm to touch. Some swelling and bruising around the incisions is normal and should improve in the days following your surgery. If the surgeon used a donor vein from your arm or leg, you will have an additional incision at the donor site. Remember to keep an eye on this incision for signs of infection, too.

Driving: You should not drive until you feel confident about performing an emergency stop without discomfort. Do not drive while taking pain medication. It is considered driving “under the influence” and is dangerous.

When to Call the Doctor

• Fever over 101.5 degrees.
• Increased redness or drainage from an incision.
• Nausea or vomiting.
• Increasing pain in the toes or foot, they have changed color, or you can’t move them. Difficulty breathing.

When to Go the Emergency Room

• Uncontrolled bleeding from the incisions.
• Persistent vomiting.
• Change in mental status.
• Inability to breathe.

You are always welcome to call the office with your questions or concerns. After hours, an answering service will direct your questions to the on-call providers. However, these individuals are unable to call in prescriptions for pain medication after 5 p.m.