Advice after your nerve block for surgery
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Why do I need an operation?
You would have had some investigations to assess the blood flow in your leg arteries. This will usually include an CT or a Magnetic Resonance scan (MRA) of your leg arteries to obtain an accurate “road-map” of the arteries This has confirmed that one or more of the main arteries that carries blood to your leg is blocked in the region of your groin, meaning blood flow to your leg is reduced, therefore so is oxygen to supply the tissues. If the blocked artery is not treated complications like infection or tissue loss can occur. You may already have pain in your leg when walking.
What is an Endarterectomy?
An Endarterectomy is an operation performed to reopen blocked arteries and restore blood flow in the body (Revascularization). It is the surgical removal of fatty deposits, called plaque, from the walls of these arteries.
What is a Patchplasty?
A ‘Patchplasty’ is usually performed in conjunction with an endarterectomy. Once the plaque has been removed from the occluded artery, a patch of synthetic material, or vein is used to patch the artery.
What happens before the operation?
Before the operation, you will be asked to attend a pre admission clinic before surgery in order for tests to be performed to ensure you are fit for the operation. This may include an ECG, a chest XRay and blood tests. Following these tests, you will be admitted to hospital on the morning of your operation.
Some patients are admitted urgently as an emergency and will have all the pre-operative tests performed as in patients.
It is vitally important that prior to the operation you keep your groin clean and dry. Regular washing with soap and water or daily showering will help. You should have a shower paying particular attention to cleaning your groin on the morning of your operation. If you are not able to shower you should wash the area. This is to reduce the risk of post operative infection. It is one of many measures we have implemented to reduce this risk.
What happens when you arrive in hospital?
Please bring with you all the medications you are already taking. You will be admitted to your bed by one of the Nurses who will note down all your personal details. The Vascular Surgeons and the Anesthetists will see you before surgery to answer any last minute questions about your operation and obtain informed consent from you for your surgery.
What happens during the operation?
You will be taken to the anesthetic room and from there into the operating theatre. You may have an epidural (injection into the back) to numb the lower half of your body during surgery and to provide pain control after surgery.
Some patients undergo this operation awake with the epidural. In other patients, a general anesthetic will be given to put them to sleep before surgery. If you have an epidural you will also have a urinary catheter inserted into your bladder to drain urine and a line inserted into a vein in your arm to help with blood pressure measurements and to give fluids following surgery.
Cuts will be made in the skin in your groin of your affected leg, In some patients this may be both. The relevant arteries are exposed, heparin (a blood thinner) is given and the arteries are clamped. The diseased artery is then opened and the occluding plaque is removed. A patch may be inserted to widen the artery. The artery clamps are then removed and the wound closed.
What happens after the operation?
After your operation, you will be given fluids by a drip in one of your veins until you are well enough to sit up and take fluids and food by mouth. If you have an epidural, this will help with pain control in the first 24 hours following surgery. In addition to this, pain killer tablets may be prescribed by your doctor. It is also likely that Heparin injections will be given to you to reduce the risk of blood clots forming in your leg veins (DVT) while you are in hospital.
Once you are up and about the urinary catheter inserted in theatre will be removed. When the catheter is removed it is quite common to have some difficulty or discomfort passing urine at first but this will get better. You should drink as much fluids as you can tolerate.
You may take a shower 48 hours after the surgery. If the wound is dry we would encourage you not to wear a dressing but ensure the area is kept clean and dry.
You may be sent home with a special dressing, to reduce the risk of infection. This should remain in place for a total of 7 days and then you may remove it . you should not need a dressing after this time.
What happens when you are discharged home?
It is normal for your leg to swell after this operation because of the improved blood supply. This will persist for up to 3 months. You are advised to elevate your leg on a stool when sitting at rest. You may be given some support stocking to help with the swelling. It is important you only wear these if they have been prescribed for you by the team. You are likely to feel tired for some weeks after your operation but this should gradually improve with time. Regular exercise such as a short walk is recommended for the first few weeks following surgery followed by a gradual return to your normal activity.
You will be safe to drive when you can perform an emergency stop without too much discomfort. This will normally be 2-4 weeks after surgery. Most patients will return to normal full activity within 6 to 12 weeks following surgery.
You may resume sexual relations as soon as this feels comfortable.
You will be sent home on a small dose of Aspirin if you are not already taking it. This is to make the blood less sticky. If you are unable to take Aspirin an alternative will be given. You will also be given a tablet to control your cholesterol levels.
What are the risks and complications of this surgery?
Slight discomfort and twinges of pain in your wound are normal for several weeks following surgery, but sometimes wounds get infected and need to be treated with a short course of antibiotics.
Sometimes slight bleeding beneath the wound can occur, resulting in some bruising; this should settle. However, if severe bleeding occurs this may result in returning to theatre.
You may have some numbness around the wound, which is due to damage to small nerves to the skin. This should improve in a few months but sometimes it is permanent.
Failure to restore adequate blood flow to the diseased arteries. This usually means that the pre-operative symptoms of arterial disease will persist. In a minority of patients, more severe symptoms of arterial insufficiency may develop due to a blood clot in the artery following surgery, this will require emergency surgery.
If your wound is red , painful or oozing there may be a risk of infection. You should contact your GP practice and vascular team if you are concerned.
Other complications such as a heart attack, stroke, kidney failure or chest infection may occasionally occur. When there is significant bleeding during the operation, a blood transfusion may be required.
What can I do to help myself?
If you smoke, it is very important that you make a sincere and determined effort to give up completely. Help may be available from the Smoking Cessation Clinic.
Continued smoking will cause further damage to your arteries. General measures such as weight reduction, a low fat diet and regular exercise are also important. You should also take your prescribed medications without fail.
Medications and Surgery
Angiotensin-converting enzyme inhibitors or ACE inhibitors (e.g., Enalapril, Lisinopril or Ramipril) should not be taken on the day of surgery.
Angiotensin II receptor blockers or ARBs (e.g., Candesartan, Losartan or Valsartan) should not be taken on the day of surgery.
Clopidogrel should be stopped 7 days pre-operatively for vascular operations except for all carotid endarterectomies or unless directed by your consultant. If you have had a stent inserted into your heart in the last 12 months, please inform your consultant and this will be discussed with a cardiologist as to the decision of when to stop your Clopidogrel.
Warfarin. If you are currently taking Warfarin this will be discussed with you by your consultant, regarding if this needs to be stopped and if you need a covering anticoagulant.
Direct oral anticoagulants or DOAC (e.g., Rivaroxiban, Apixaban or Dabigatran).
This should be stopped at least 48hrs prior to the procedure if high risk of bleeding. If your kidney function is abnormal, this may need to be discontinued for a longer time period prior to surgery. If you take Ticagrelor it will need to be discontinued for 5 days. Your consultant will advise about this.
Following the procedure, the DOAC will be restarted after 24-72 hours at the discretion of your consultant. You will be started on an anticoagulation injection (e.g., Dalteparin) to help prevent blood clots on the evening of the procedure and daily until the DOAC is restarted. This will be stopped once the DOAC has been restarted.
T.E.D Anti-embolism stockings should never be given for arterial patients unless specifically directed by the consultant. If you are asked to apply a pair, please can you question this with a member of the vascular team.
Along with toiletries, night clothes, etc., the vascular team actively encourages all our patients to bring in day clothes to wear on the ward whilst an inpatient and to have ready for discharge.
Contact Details
Secretaries at Frimley Park
Mr D J Gerrard, Mr Chong, Mr Chaudary 03006132141
Mr K Jones, Mr Cleanthis, Miss Moore 03006134291
Lt Col Sharrock, Mr Ali, Mr Dastur 03006132487
North Hants Hospital Basingstoke Secretary
Wexham Park Hospital Secretary
Vascular Specialist Nurses
Claire Martin Lead Vascular CNS - FPH 0300 6136302
Tracey Craig Vascular CNS - FPH
Andrea Croucher Vascular CNS - FPH
Pabita Limbu Vascular CNS - FPH
Kirstie Lane Vascular CNS - WPH 07770702053
Nessa Cababa Vascular CNS - ASPH 07522618600
Contact us
If you have any queries relating to this information, please contact the Vascular surgery service.
About this information
Service:
Vascular surgery
Reference:
Y/037
Approval date:
7 March 2024
Review date:
1 March 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.