Vascular surgery

An aortic aneurysm is a bulge in a section of the body's main artery known as the aorta. The aorta carries oxygen-rich blood from the heart to the rest of the body. Because the section with the aneurysm is overstretched and weak, it can burst. If the aorta bursts, it can cause serious bleeding that can quickly lead to death. Aneurysms can form in any section of the aorta, but they are most common in the abdominal area.

Learn more about what causes an AAA, the symptoms, risk factors, diagnosis and treatment options.

Angioplasty is a non-surgical procedure that can be used to open blocked heart arteries. Stent placement is another option that can be done during angioplasty. The procedure is performed in the cardiac catheterization laboratory or cath lab.

Learn more about angioplasty.

The body has two systems of veins, the superficial and the deep. The deep system exists in the muscles of the body. A deep vein thrombosis or DVT occurs when a blood clot forms in a vein of the deep system.

Learn more about this condition by arterial and DVT thrombectomy.

Bypass grafts can be used to reroute blood flow around the section of an artery that may be blocked.

Learn more about bypass grafts.

Before hemodialysis treatments for kidney disease can begin, a surgeon creates an access where blood can flow in and out of the body. This is usually done by joining an artery and a vein in the forearm or by using a small tube to connect an artery and a vein.

Learn more about dialysis access.

Endovascular surgery is a form of minimally invasive surgery that is an alternative to traditional surgery to treat different vascular conditions such abdominal aortic aneurysms. Stents and coils are composed of fine wire materials that can be inserted through a thin catheter and expanded into a predetermined shape once they are guided into place.

Learn more about endovascular repair.

A stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow access for surgery.

• Renal stenting.
• Lower extremity stenting.
• Carotid stenting.
• Carotid endardectomy (CEA) is a surgical procedure used to prevent stroke, by correcting narrowing in the common carotid artery. During an endardectomy, surgeons remove material that is clogging or thickening the artery.

Learn more carotid endardectomy.

Mesenteric ischemia is a medical condition in which inflammation and injury of the stomach and small or large bowel result from inadequate blood supply. Causes of the reduced blood flow can include changes in the systemic circulation or local factors, such as constriction of blood vessels or a blood clot. Symptoms can vary from mild to moderate abdominal pain and weight loss to severe pain and bowel necrosis (gangrene) that can lead to death if untreated. Depending on the etiology and presentation, it can be treated with minimally invasive surgery (endovascular surgery, which includes thrombolysis, angioplasty, stenting) or with open surgery (bypass or embolectomy).

This type of surgery is less invasive than open surgery. A minimally invasive procedure typically involves the use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device, and are carried out through the skin or through a body cavity or anatomical opening. When there is minimal damage of biological tissues at the point of entrance of instrument(s), the procedure is called minimally invasive. This may result in shorter hospital stays, or allow for outpatient treatment.

When a weak area of your thoracic aorta expands or bulges, it is called a thoracic aortic aneurysm (TAA).

Learn what causes a TAA and how it is treated.

Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.

Learn more about how thrombolytic therapy works.

You will receive a call from a registration representative to obtain and verify:

• Insurance.
• Emergency contact person.
• Family physician.
• Surgeon.
• Date of surgery.

What to bring to your appointment:

• A list of all medications (prescription and non-prescription, including dosage, how often you take them and why they are prescribed). If it is more convenient for you, bring all your medicines, including inhalers and eye drops, with you to the pre-admission appointment.
• A complete list of allergies.
• All paperwork from your surgeon, including orders and consent for surgery.
• Insurance cards and photo identification.
• If you have had recent lab work, electrocardiogram (EKG), chest x-ray or any diagnostic testing, bring copies to your appointment. Lab work must be within one month of surgery. The EKG and chest x-ray must be within six months of surgery.
• Copies of your living will and healthcare power of attorney.

You should plan for the pre-admission process to take at least two hours at the hospital. A spouse or family member is welcome to accompany you to your appointment. You will have lab work, EKG and chest x-ray, if ordered, and a nursing interview. Your surgical history, medical history and discharge planning will be started at this interview. If any preparation for your surgery is required, we will discuss how, when and what to use.

Ask your surgeon which medicines to stop before your surgery, and when. Over-the-counter medications that thin your blood should be stopped before surgery (Naprosyn, Ibuprofen, Aspirin, Vitamin E, Garlic, Aleve). Discuss when to stop taking any prescription blood thinners with your surgeon.

If you become ill or have a cold or fever, please call your surgeon within 24 hours of your surgery time.

• If you usually take medication in the morning, you should take it with a small sip of water prior to coming to the hospital.
• If you take Plavix (clopidogrel), you should take your last dose on the 5th day prior to the procedure and then stop taking it.
• If you take Coumadin (warfarin), you should take your last dose on the 4th day prior to surgery and then stop taking it.
• If you take metformin (glucophage), you should take your last dose on the morning prior to surgery, and then stop taking it.
• If you take insulin, you should take half your normal dose the day of surgery.

• Do not take food or liquids for eight hours before surgery.
• No gum, chewing tobacco, or smoking after midnight the day before your surgery.
• No eye makeup or hair spray.
• Please brush your teeth and shower.
• Take medications as directed by the pre-admission nurse or your surgeon.
• No jewelry or body piercing will be allowed.
• Leave all valuables, including medications, at home except inhalers and eyedrops.
• If you are spending the night, you may bring a small overnight bag with personal care items.
  • You will be asked to change into a hospital gown, slippers, and robe. No undergarments will be worn to surgery.
• You may be given stockings to prevent blood clots.
• Your heart rate, blood pressure, height and weight will be recorded. Anesthesia is based on these numbers.
• Your surgeon will mark your surgical site to confirm the planned operational area.
  • All clothing will be bagged and locked securely until you depart.
• If you are spending the night, your clothing will be placed in your assigned room after surgery.
• Please have someone available, in person or by phone, for your surgeon to talk with after surgery.
• An anesthesiologist will review your medical history, medications and discuss anesthesia options that are best for you.
• An intravenous (I.V.) line will be established and medication given for relaxation/anxiety. Tell the anesthesiologist any problems you or your blood relatives may have had with anesthesia in the past.

• You may not remember this because of sedation, but we will apply heart, oxygen and blood pressure monitors. You will receive an antibiotic to prevent infection if necessary.
• If you receive general anesthesia, you will have medications administered through the I.V. line, and be asked to inhale oxygen. The next thing you will remember is the recovery room.
• Glasses, dentures, and hearing aids will be removed if still in place.

• You will be receiving oxygen when you wake up.
• If you have pain or nausea, please tell the nurse and medications will be given to you.
• Pain medicines are available. Ask your nurse. Do not allow pain to become severe.
• You will be kept warm to help prevent infection.
• No visitors are allowed in the recovery room.
• If you have glasses, dentures or hearing aids, these items will be returned to you.

• You will be taken to an assigned room after recovery room. The staff will have placed your clothing and personal belongings in your room.
  • You may have an oxygen mask in place for 2-3 hours to help healing. You will be asked to deep breathe and cough to help prevent pneumonia.
• Pain medicines are available. Ask your nurse. Do not allow pain to become severe.
• Nausea medicines are available if needed.
• Your family will be directed to your room when you leave the recovery room.
• You will get out of bed after surgery, as soon as your physician orders it. A nurse will help you.
• Routine medications from home will be given to you as ordered by your surgeon.
• You should have someone available to help after discharge.

• After leaving the recovery room, you will return to day surgery.
• Your family will be able to see you.
• Liquids will be offered.
• After you are able to tolerate liquids, your I.V. will be removed.
• All discharge instructions will be given to you and your family.
• After you are dressed, we will assist you to your car. You must have someone available to take you home.
• You should have someone available to assist you at your home.

• Do not remove any bandages until directed by your surgeon.
• DO NOT DRIVE FOR 24 HOURS.
• Take medication as prescribed before your pain becomes severe.
• Do not allow your surgical area to get wet until directed by your surgeon.
• Return to work only after your surgeon has cleared you to do so.
• Follow all discharge instructions given to you at the hospital.