Surgery of the Aorta
Abdominal Aortic Aneurysm Repair, Thoracic Aortic Aneurysm Repair, Aortobifemoral Bypass, and Endarterectomy
The Aorta
The aorta is the largest blood vessel in the body. It is also the most important blood vessel. It gives oxygen-rich blood from the heart to every other organ system. If there is a problem with your aorta it can decrease the blood flow to the rest of your body.
An aortic aneurysm is a weakened part of the blood vessel. It looks like a bulge or balloon in the wall of the aorta. An aneurysm can happen in the part of the aorta that is in the chest or in the abdomen. If it happens in the chest it is called an abdominal aortic aneurysm. Aneurysms that are in both the chest and the abdomen are called thoraco-abdominal aneurysms. If an aneurysm bursts or tears, it can cause life-threatening bleeding. Surgery to repair the aneurysm may be needed.
There can also be a blockage of the aorta further down your body. This can decrease blood flow to your legs. Surgery can help bypass or remove the blockage. This will increase the blood flow to your legs. The surgery to bypass the blockage in the lower aorta is called an aortobifemoral bypass. The surgery to remove the blockage is called an endarterectomy. An endarterectomy can be done on the aorta, or on the branches of the aorta that feed the kidneys or gut.
The Surgery
The surgeries to fix an aortic aneurysm or blockage in the aorta are done under general anesthesia. This means you will be asleep during surgery. This type of surgery takes three to six hours. Based on the site of your aneurysm or blockage, your surgeon will make an incision into either your chest or your abdomen. If you are having an aortobifemoral bypass you will have an incision in your abdomen and in each side of your groin.
During the surgery, the surgeon puts clamps above and below the damaged or blocked part of your aorta. To fix an aneurysm, the surgeon opens the damaged part of your aorta. Then, the surgeon sews in a fabric graft to make the walls of the aorta stable. To bypass a blockage, the surgeon sews a fabric graft to the aorta above and below the blockages. This is called a bypass because the graft will send blood around the blockages. To remove a blockage, the surgeon cuts the plaque that is causing the blockage from the blood vessel wall. The incision is then closed with staples or stitches. A dressing is put over your closed incision.
What to Expect before Surgery
You will not be able to eat or drink anything for at least 12 hours before your surgery. The night before your surgery you may need to take a medicine to help you have a bowel movement. This will clear your bowels out for the surgery.
What to Expect after Surgery
After surgery you may be moved to an intensive care unit (ICU) or to an intermediate care unit (IMC). We will closely watch your heart rate, blood pressure, and blood oxygen level. If you are moved to an ICU, you will be moved to a standard hospital room one to three days after surgery.
When you wake up you will have some tubes and lines attached to you. At first, you may have a breathing tube to help you breathe. It will be taken out when you can breathe on your own. You will have an intravenous line (IV) in your arm or neck for medicine and fluids. You will also have an arterial line. This is in the artery in your wrist and is used to measure your blood pressure and draw blood. You will have a foley catheter in your bladder to drain urine. You may have other drains either in your stomach, your incision, or your spine. You will be given medicine to help your pain at the incision.
You may have blood tests, X-rays, ultrasounds, or other procedures. You may also need to wear compression stockings. These stockings help prevent blood clots in your legs. You will not be able to eat or drink for a few days. You will slowly be able to eat more each day. As you recover, you will work with nurses and physical therapists to get back your strength.
Most patients who have this surgery can go home within five to seven days.
Incision Care
Your incision is most often closed with staples or stitches. You may get the incision wet in the shower. Do not swim or take tub baths. Clean the incision gently with mild soap and water. Remove any dried drainage. Do not scrub the incision. Rinse it and pat the incision dry. Do not use any lotions, alcohol, powders, or oils on your incision, unless told by your doctor. The doctor and nurses will tell you how to take care of you incisions at home. Most incisions can be left open to air except for incisions in the groin. Groin incisions need a dressing. Make sure you let the incision dry completely before replacing the dressing.
At your first follow up clinic, visit your staples or stitches may be removed. Small pieces of tape called Steri-Strips® may be placed on the incision to help support it. You may shower with the Steri-Strips® in place. Allow the water to flow gently over the area. Do not rub the incision. Gently pat the incision dry. After 2-3 days the Steri-Strips® will begin to curl up at the ends. With time, the strips will fall off on their own. Do not swim or take tub baths.
Activity
When you go home you should be able to do most of your basic daily routines. You will need to give yourself time for rest. You may feel weaker. You may notice that you become tired more easily than before. This is normal. Your sleeping pattern should return to your normal. It may take 6 to 8 weeks for you to feel like yourself again. Your strength and energy level will increase as your body recovers. Walking is good for you. It is important that you start slowly. You should increase your distance a little bit each day. This will help you become stronger. Walking will also help prevent constipation and blood clots.
There are some things that you should not do in the first few weeks after surgery.
- Do not lift more than 5-10 pounds during the first 6 weeks at home. This includes groceries, pets, and children. One gallon of milk is about 8 pounds.
- Do not drive until your doctor says it is okay. This is most often not until after the first clinic visit. Do not drive while taking narcotic pain medicine.
- Do not play contact sports or do exercise other than walking until your doctor approves.
- Ask your doctor at your follow-up visit when you may return to work and resume sexual activity.
- If you had an aortobifemoral bypass you should not sit for longer than 1 hour at a time. Make sure to elevate your legs when you are sitting.
Pain
It is normal to have some pain at your incision. You may also have pain in your abdomen, chest, back, or groin. Your doctor may have prescribed pain medicine for you to use at home. This is often the same medicine you have been taking in the hospital. The pain will decrease as the incision heals. You should then need less pain medicine. At that time you can use an over-the-counter pain medicine. Talk to your doctor before starting any over-the-counter pain medicine. Do not drive while taking narcotic pain medicine.
The narcotic pain medicine can make you constipated. It is important to prevent constipation. You can use over-the-counter stool softeners (Senna/Docusate) as needed. Other ways to prevent constipation include drinking fluids and eating fiber. Vegetables and fruits (prunes, raisins, apples, oranges, potatoes, spinach, and carrots) and whole grain breads/rice have fiber. Staying active also helps prevent constipation.
Diet
It is common after this type of surgery to have less of an appetite. You may even lose weight. Even if your appetite is poor you should try to eat. Eating well helps your body heal. It may be easier to eat small amounts of food several times per day instead of eating three large meals. It is also important to drink enough fluid to stay hydrated. If you are dehydrated you can become tired and weak more easily. Drink at least 8 to 10 eight-ounce glasses of fluid each day. Water and milk are good options. Caffeine-containing drinks (soda, coffee) can dehydrate your body so are not the best choice for helping you to stay hydrated.
You should also be eating a heart healthy diet.
- Eat less saturated fat. Eat less fatty meats, fried foods, butter, and whole milk dairy products.
- Eat less trans fats. Eat less deep fried foods, donuts, cookies, and desserts.
- Eat less carbohydrates. Eat less sugars and sweetened drinks.
- Eat less sodium. Eat less processed foods. Do not add extra salt to your food.
- Eat less cholesterol. Eat less egg yolks, shrimp.
Antibiotics
You will need to tell your dentist before you have any dental work done. Your dentist will order an antibiotic for you to take before your procedure. This is because of the aortic graft. Also tell your doctors about your aortic graft before planning any other surgeries or procedures. Your doctors will decide if you need antibiotics at that time.
When to Call the Doctor
- An increase in redness or warmth at the site of the incision.
- Red streaks on your skin that extend from the site where the stitches or staples are.
- Bulging or swelling at the incision.
- New drainage or bleeding from your incision. Drainage may be cloudy, yellow, green, or foul-smelling.
- Open spots between the stitches/staples where the skin is pulling apart.
- If you notice the skin along the incision is getting darker or turning black.
- Sudden increase in pain that is not relieved by your pain medicine.
- A temperature of more than 101.5° F (38.5°C) by mouth for two readings taken 4 hours apart.
- A new onset of weakness in your legs.
If you had an aortobifemoral bypass, call your doctor if you have
- Sudden increase in tenderness or swelling in your leg.
- Sudden increase in redness, warmth, or a bluish skin discoloration in your leg.
- Increased swelling in your leg that does not go down after raising your legs overnight.
- Numbness in your foot or leg.
- Your leg or foot becomes cooler to the touch.
- If your leg becomes grey or white.
Follow up
You will most often return to the Vascular Surgery Clinic about two weeks after you go home. Your staples or stitches may be removed at this visit.
How Do I take Care of Legs and Feet with Poor Blood Flow?
- Look at your legs and feet daily. Let your doctor know if you see any sores, scratches, cracks, blisters, or reddened areas.
- Wash your legs and feet daily with mild soap and water. Do not soak your feet. Dry them well.
- Put lotion on dry skin daily. Do not put lotion between your toes.
- Let a doctor or nurse clip your toenails or show you how to clip toenails.
- Wear shoes that fit well.
- Wear white cotton or wool socks.
- Check shoes and socks for stones, sharp things, or holes.
- Do not use heating pads or hot water bottles on your legs or feet.
- Never walk without shoes.
Phone Numbers
Vascular Surgery Clinic at (608) 263-8915 from 8:00 am to 5:00 pm Monday through Friday.
After hours, call hospital paging at (608) 263-6400. Ask for the Vascular
Surgery doctor on-call. Give paging your name and phone number with the area code. The doctor will call you back.
If you live out of the area, call 1-800-323-8942.
References
Fahey, Victora A. 4th Ed. Vascular Nursing. Philadelphia: WB Saunders Co., 2004.
Dehydration. www.medicinenet.com
Constipation. www.medicinenet.com
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 07/20/2011
Copyright © 07/20/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4885
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