Preparing for Vascular Surgery

Vascular problems can be broken down into two categories: They either affect your arteries or your veins.  

Vascular operations come in two forms as well. They include open surgery, in which the surgeon makes a cut in your skin to fix the problem; and endovascular surgerya minimally invasive procedure performed through a small needle hole in the artery or vein. 

Dr. Christopher Agrusa, an Assistant Professor of Surgery and Assistant Attending Surgeon at Weill Cornell Medicine, lists the most common vascular conditions that require surgery: 

  • plaque build-up in the arteries of the legs, called peripheral arterial disease (PAD) 
  • plaque build-up in the carotid arteries that supply blood to the brain (carotid artery stenosis) 
  • aneurysms 
  • blockages of the veins  
  • access for hemodialysis   

Often,” he explains, both open and endovascular surgery can be used to treat the same problem. The decision to perform an open vs. an endovascular operation is based on the needs, medical history and anatomy of the individual patient. 

Take the time to review Dr. Agrusa’s answers to your FAQs below. 

Which procedures can be performed on an oupatient basis? Which may require a hospital stay? 

  • Most endovascular procedures performed on the legs or arms can be performed on an outpatient basis. Additionally, most dialysis access procedures are outpatient procedures.   
  • Endovascular repair of aortic aneurysms, endovascular stenting of the carotid artery and open repair of carotid artery disease usually require an overnight hospital stay.   
  • Open surgery to repair aortic aneurysms and open surgical bypass surgery for lower extremity arterial disease typically require a 2 to 7-day hospital stay.   

Pre-operative guidelines 

If you’re scheduled for vascular surgery, you’ll have an opportunity to discuss pre-operative guidelines with your surgeon, Dr. Agrusa says. Typically, you’ll be asked to refrain from taking blood-thinners or anti-platelet medication before surgery. If you take Metformin for glucose control, you’ll likely need to stop taking this medication for 48 hours before surgery.    

Most vascular procedures are performed with some type of anesthesiaeither general anesthesia or intravenous sedation. Patients undergoing vascular surgery will be required to fast starting at midnight before the morning when surgery is scheduled.   

What information will I need to provide to my care team beforehand? 

It is imperative that your surgeon know about any allergies you may have. These may include allergies to anesthesia—local or general—and to medications, including heparin.  

In addition, many endovascular procedures use iodine-containing contrast dye. If you have ever had an allergic reaction to contrast, it is important to let your surgeon, nurse and anesthesiologist know. Often, patients can receive the contrast dye in tandem with certain medications that reduce your body’s immune reaction to it.   

Should I arrange to be picked up when I’m discharged from the hospital? 

Any patient who receives conscious sedation or general anesthesia will require an escort to leave the hospital if being discharged on the same day as surgery.   

Any additional pointers or qualifications? 

Says Dr. Agrusa, “Most patients undergoing vascular surgery have other medical problems that may increase their risks during or after their procedure. For this reason, it is important to discuss all of your medical issues with your surgeon before surgery. You may be required to obtain medical or cardiac clearance before undergoing a vascular procedure.” 

How long will it take for me to recover from a vascular procedure? 

  • After an endovascular procedure for peripheral artery disease or aortic aneurysm, recovery usually takes just a couple of days. Many patients feel well as early as the same day as the procedure. You may be asked to refrain from strenuous activity for up to a week. 
  • Recovery after open surgical bypass or aneurysm repair can take longer. Many patients require multiple days in the hospital before being discharged. Once you’re home, it an take up to three months to achieve full recovery. 

You’ll need to follow-up with your surgeon after vascular surgery within 2 to 4 weeks of the procedure,” Dr. Agrusa says.   

To make an appointment with a vascular surgeon, please visit here to learn more