Arterial Disease Treatment

After the procedure, patients should avoid driving or operating equipment for the first 24 hours, but they can walk around the house and do light activity.

It can take 6 to 8 weeks to fully recover from PAA, and the leg on the side of the procedure may be swollen for a few days or weeks.

Peripheral arterial bypass grafting, also known as peripheral vascular bypass or lower extremity bypass, is a surgical procedure that reroutes blood flow around a blocked artery in the leg. The procedure uses a graft, which is a special tube that replaces the blocked part of the artery. Grafts can be made from natural human tissue or synthetic materials like Dacron or polytetrafluoroethylene (PTFE). The graft is often a vein taken from another part of the leg, but can also be a man-made blood vessel.

During the procedure, the surgeon makes an incision over the blocked artery, usually in the leg, groin, or lower belly. Clamps are placed on either end of the blocked section, and the graft is sewn into the artery to create a new pathway for blood flow. Before closing the incision, the surgeon will check to make sure blood is flowing through the graft correctly.

After surgery, patients typically stay in the hospital for a few days to a week. They may need to spend 1–3 days in the intensive care unit (ICU) before moving to a regular hospital room. During recovery, patients may experience mild pain and swelling at the incision site, as well as fatigue for a few weeks to a month. Their doctor may recommend physical therapy, and patients should arrange for someone to drive them home from the hospital. Once home, patients may need help with everyday tasks for a week or more, and should avoid strenuous activities for as long as their doctor recommends. It’s also important to keep the incision area clean and change the surgical dressing frequently to prevent infection.

After the blood flow is restored, symptoms usually improve or go away completely. However, it’s important to maintain a healthy lifestyle to prevent future blockages. Patients should contact their provider if they experience any of the following problems after going home: Fever or chills, something coming out of the incisions, and any change in how the leg looks or feels.

Peripheral Angioplasty and Stenting. Angioplasty is a procedure that uses a catheter and a balloon to open up blocked arteries. Stenting happens after angioplasty during which your surgeon inserts a small metal device in the artery. The stent helps keep the artery open and improve blood flow.

During the procedure, a doctor inserts a flexible tube, called a catheter, into the artery through a cut in the groin and uses X-rays to guide it to the blockage. The stent is then passed through the catheter and implanted into the artery, where it remains permanently. Stenting is often performed in conjunction with angioplasty, a procedure that uses a balloon catheter to open the artery.

After the procedure, most people can go home from the hospital in two days or less and should be able to walk around within 6 to 8 hours. Your provider will explain how to take care of yourself.

Carotid endarterectomy (CEA) is a surgical procedure that reduces the risk of stroke by removing plaque from the carotid arteries. The carotid arteries are the main blood vessels that supply blood to the brain, face, and neck. When plaque, a fatty substance, builds up in the carotid arteries, it can narrow them and reduce blood flow to the brain, which can increase the risk of stroke.

During a CEA, a surgeon makes an incision in the neck over the affected carotid artery, opens the artery, and removes the plaque. The surgeon may also leave a small tube in the wound to drain any blood that builds up after the operation. After the procedure, patients are usually moved to the recovery area to be monitored.

Most patients can return to normal activities within 3 to 4 weeks, but may experience a slight neck ache for about 2 weeks. They may also need help with meals, shopping, and other tasks at first.

The two main risks of a CEA are stroke and death. The risk of stroke is around 2%, but may be higher for people who have had a stroke before the operation. The risk of death is less than 1%, and can occur as a result of complications such as a stroke or heart attack.

Transcarotid artery revascularization (TCAR) is a minimally invasive surgical procedure that treats carotid artery disease (carotid stenosis) and prevents strokes:

• The surgeon makes a small incision in the neck, just above the collarbone.
• A tube is inserted into the carotid artery and connected to a system that temporarily reverses blood flow away from the brain.
• The blood is filtered and returned to the body through a second tube.
• A stent is inserted into the artery to stabilize plaque.

TCAR is designed to minimize the risk of stroke by keeping potential stroke-causing fragments away from the brain. Patients typically spend just one night in the hospital and recover quickly. Before leaving the hospital, a doctor will provide advice for activity, diet, and medications. Patients will be asked to avoid hard activities like lifting for at least a week and will be told when they can resume normal activity and return to work. Doctors will also prescribe medications to prevent blood clots from forming in the newly opened artery.

TCAR can be performed under either general anesthesia or MAC, with the anesthetic technique based on neck anatomy and the patient’s ability to tolerate lying still.

Endovascular aneurysm repair (EVAR) is a minimally invasive procedure to treat an abdominal aortic aneurysm (AAA) from the inside of the aorta, the body’s largest artery:

• A vascular surgeon makes a small incision in the groin or arm
• The surgeon threads a catheter into the incision and through a blood vessel to the aneurysm
• Dye is injected into the arteries to help the aorta show up on X-ray
• The surgeon uses the catheter and small tools to place a fabric tube (endograft stent) inside the aneurysm
• The endograft expands to exclude the aneurysm sac from blood flow and pressure

EVAR can help relieve pressure on the aneurysm and prevent it from rupturing. Benefits of the procedure include a faster recovery, shorter hospital stay, and less pain after surgery. However, there are some risks associated with EVAR, including:

• Wound infection at the groin
• Groin hematoma
• Damage to surrounding blood vessels, organs, or other structures
• Kidney damage
• Limb ischemia (loss of blood flow to leg/feet) from clots
• Bleeding

After the procedure, patients are usually sedated and monitored for heart rate, blood pressure, breathing, and blood oxygen level. They may also receive medication to help them relax and for pain relief. Many people can go home the next day and return to their normal activities, but they should avoid rigorous exercise and heavy lifting for two weeks

Open abdominal aortic aneurysm (AAA) repair is a major surgical procedure that involves replacing a widened section of the aorta with a synthetic graft:

• The patient is given general anesthesia and the surgeon makes a large incision in the middle of the abdomen, from just below the breastbone to below the belly button
• The surgeon clamps the aorta to stop blood flow, opens the aneurysm, and removes any debris
• The surgeon replaces the diseased section of the aorta with a graft, which is a cylinder-like tube made of a cloth-like material or other synthetic material

Open AAA repair is a safe and effective procedure that can prevent aneurysm rupture and has a good long-term outlook. However, there is a risk of complications, including heart attack, stroke, kidney failure, and infection. The procedure usually takes about three hours and patients typically stay in the hospital for 7–14 days, spending some time in the intensive care unit. It can take several months to return to normal activities and work.