What to expect when you have your surgical procedure
Because aortic surgery is an abdominal surgery, you will need to take a laxative and clear liquid diet prior to the day of surgery. This is a major surgery and sometimes requires you to be evaluated by a cardiologist and/or pulmonologist before proceeding. You will have to have pre-operative lab work that includes a chest X-ray and EKG.
Just before surgery, the anesthesiologist will place multiple catheters, which will allow continuous monitoring of the overall fluid status in your body. An arterial catheter is placed in your wrist to constantly monitor your blood pressure throughout your surgery and while you are in the critical care unit. An IV inserted into a neck vein (usually on the right side, called a "Swan Ganz") allows for direct heart pressure monitoring. A Foley catheter is placed in your bladder to continuously monitor urine output. Because the intestines tend to shut down after abdominal surgeries, you will have a tube from your nose to your stomach (nasogastric or "NG" tube) for 2-3 days following surgery. This tube is required to keep the stomach empty and free of air to avoid nausea and vomiting. All of these tubes and catheters are meant to make the surgery safer and to provide your care team with information essential to your treatment.
The operation usually takes 2-4 hours. You will spend at least 1 night in the critical care (intensive care) unit. Your incision will likely be closed with staples, and you can expect some incisional pain. This will be controlled in the hospital with IV, epidural and oral medication. You will be given a prescription for pain pills when you leave the hospital. Your activity level will gradually increase, starting with getting out of bed the evening or day after surgery. You will start walking soon after that, as your catheters and tubes are removed.
What to expect when you leave the hospital
You will be discharged from the hospital 5-7 days following surgery. Expected recovery time to the point where you are moving about comfortably is approximately 2-3 weeks. You will likely be able to return to work in 2-6 weeks depending on the level of activity required. It is not uncommon to have some redness in the area where you had your surgery. The redness should gradually fade. You will have lifting restrictions, and you should not carry anything heavy for at least 6 weeks while your wounds are healing. You should walk regularly and gradually increase activity.
Smoking increases your risk of having complications, as does having diabetes. Serious complications of having aortic surgery can include cardiac complications (heart attack or heart rhythm abnormalities) and lung complications (pneumonia or respiratory failure). Either of these could result in the need for a breathing tube and ventilator after surgery and can even result in death. There is also a risk of kidney failure, especially if the surgery involves cleaning out the kidney arteries (these arteries are very near and sometimes part of aneurysms).The aorta also has important branches that go to the intestines, and there is a slight risk of decreased circulation to the intestines following surgery. There is up to a 20% chance that erectile dysfunction will occur. Though the operation is designed to repair or replace arteries which may take blood to the kidneys, intestines and legs, problems with blood clots to these areas can be encountered.
The most common post-operative complication is fluid drainage from the incision. The discharge can be straw-colored like urine, pink or even red-brown like old blood. Other potential complications include bleeding, seroma (the collection of lymph fluid that can cause good-sized lumps under the skin near incision lines), infection, blood clots (resulting in loss of circulation to legs, intestines or kidneys) and skin nerve damage (this is due to the unavoidable disruption of the nerves along the incision lines and can result in numbness or stinging across the thigh but does not affect the ability to walk).
You should call the doctor immediately
- If your surgical site becomes so swollen that it is begins to open up
- If the swelling increases suddenly (over a few minutes)
- If you have any symptoms of loss of circulation to your leg(s) such as a cold or discolored foot, and increased pain
- If you have severe, suddenly worsening abdominal pain, cramping and foul-smelling diarrhea
You should also notify the physician if you experience signs or symptoms of infection:
- Redness that gets worse rather than better
- Drainage from the wound that is like pus
- Fever greater than 100° F
You should arrange a follow-up appointment with your physician 10-14 days following surgery for staple/suture removal. You will need to call the office to arrange an appointment time. Once the incision line has healed completely, using a vitamin E ointment or a moisturizing cream may help reduce scarring.
You may notice some numbness along your incision line or even some strange sensations with walking after surgery. This is not uncommon and often will resolve within a few weeks after surgery. Sometimes the numbness can last for months, and in some cases, may not go away. This is due to the unavoidable disruption of the nerves along the incision lines.
Your activity restrictions are minimal. If you drive, you may resume driving 1-2 weeks following surgery, as long as you are no longer taking pain pills and can comfortably move your foot to and from the gas pedal and brake. After 1 week, you may gently begin to return to your normal range of motion.
You may shower 72 hours after surgery and pat the incision lines dry.
You should expect to take one enteric-coated aspirin (EC aspirin) every day from now on unless specifically instructed to do otherwise. Taking 1 aspirin a day (or the prescribed alternative) will help the graft(s) stay open and reduce the chances that you will need additional vascular surgery in the future. Sometimes Coumadin® or anti-platelet medications like Ticlid or Plavix are required. Maintaining blood flow through your new graft(s) will be an ongoing process. You can help maintain your graft in several ways. First, Don't Smoke! Smoking increases the risk of graft failure, both in the short and long term. Next, take your medications as directed. Anti-platelet agents or blood thinners help maintain the aortic graft. If you are diabetic, maintaining good blood sugar control will reduce the progression of new arterial plaque (plaque contributes to graft thrombosis). If your cholesterol or triglyceride levels are elevated, these should be corrected with dietary changes and, when necessary, medication.
Please call our office if you have any additional questions or concerns about aortic surgery. We want to ensure that you have all of the information you need to make informed choices regarding your care.