Your Artery Operation - Some Information

These notes give a guide to your stay in hospital. They also give an idea about what it will be like afterwards. They do not cover everything. If you want to know more, please ask.

What is an Aortic Aneurysm?

The aorta (ay-ort-er) is a big artery which carries blood from your heart to your legs. It runs deep in your tummy down to the level of your navel. There it branches into the 2 arteries which run down to your legs.
Sometimes the aorta forms a blow-out like a balloon (an aneurysm, ann-your-ism). This is dangerous because the aneurysm can leak or burst, causing fatal internal bleeding. Sometimes pieces of the lining of the aneurysm break off and block the leg arteries.
The aneurysm needs to be replaced by a new artery.

What does the operation consist of?

During the operation, you will be asleep with a general anaesthetic. If the operation is an emergency, you may be awake in the operating theatre while we make preparations. However, you will be asleep when the operation begins.
A cut is made in the skin of the tummy , usually to the left of the navel, from the ribs down to the groin. A new artery, made of a tube of very strong plastic fabric, is stitched in place inside the aneurysm. The cut in your tummy is then stitched up.
Sometimes the 2 arteries which run to your legs have aneurysms as well. Then we use a new artery shaped like a pair of trousers to make the repair. The turnups of the trousers are stitched to the leg arteries. An extra cut in each groin is needed for this type of operation.
You will need a blood transfusion during and after the operation.
The new arteries last for 20 years and more.

Are there any risks?

An aneurysm is a very serious condition. If the aneurysm is operated on before it leaks, 95% of patients will survive and do well. If the aneurysm has leaked, the chances of a successful outcome may be only 50%.
The patients who do not do well may not survive their time in the operating theatre.
Patients who are under 70 years old, not overweight and free from heart, lung and other illnesses, do best.
Blockage of the arteries of the legs by blood clot from the aneurysm may lead to damage to toes and feet. Some form of amputation may be needed in about 1 in 10 patients, particularly emergency cases.
Other problems such as strokes and blood clotting in the lungs may happen in perhaps 1 in 10 patients.
Other more rare complications include kidney failure, problems with the prostate needing other operations, infected grafts, and weaknesses in the tummy wounds. Rarely, the blood supply to the bowel or the spine are cut off. We can go into these details as you wish.

Are there any alternatives?

If you leave things as they are, there is a high chance of the aneurysm bursting. Also, as the aneurysm gets bigger, it becomes more difficult to operate on.
Smaller operations do not work.
Wrapping the aneurysm to support it, taking out the aneurysm, and filling the aneurysm to prevent it leaking are not as good as grafting the aorta.
Threading a special frame up the leg artery to support the aneurysm is still experimental.
If you have more than one aneurysm, we will deal with them as needed.
If one or more leg arteries are blocked, we may well operate on them at the same time as your aneurysm operation. They may need to be cleared out or bypassed with new artery material.
Tablets and medicines will not be helpful, neither will x-ray and laser treatment. I am sure the best way forward is to have the planned operation.

What happens before the operation?

If the operation is done as an emergency, the preparations below will need to be carried out very rapidly. There may not be time to discuss the operation with you in such detail.

Welcome to the ward

You will be welcomed to the ward by the nurses or the receptionist. You will have your hospital details checked. You will be shown to your bed and will be asked to change into your nightwear. You will have some basic tests done, such as pulse, temperature, blood pressure and urine examination.
You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings.
Sometimes all these preparations are done in a preadmission clinic a few day before you come into the hospital for the operation.

Visits by the surgical team

You will be seen by the House Surgeon, who will interview and examine you. He, or she, will arrange some special tests such as x-rays and blood samples. The operation will be explained to you. You will be asked to sign your consent for the operation. If you are not clear about any part of the operation, ask for more details from the doctors or from the nurses. They are never too busy to do this.
You will have the operation site marked on you with a skin pencil.
You will be seen by the surgeon who will be doing the operation. He will check that all the necessary preparations have been made.

Visits by the anaesthetic team

One or more anaesthetists who will be giving your anaesthetic will interview and examine you. They will want to know about chest troubles, dental treatment and any previous anaesthetics you have had. Also, they will want to know about other illnesses you have had, plus any anaesthetic problems in the family.

Visit by the physiotherapist

The physiotherapist will show you how to keep your chest clear after the operation and how to keep moving about. You should not smoke.

Diet

You will have your usual diet until 6 to 12 hours before the operation. Then you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during your operation.

Shaving

You will be shaved from armpit to thighs to prevent hairs affecting the wound.

Periods

The periods do not affect the operation.

Bowel preparation

Special treatment for the bowels is not needed.

Timing of the operation

The timing of your operation is usually arranged the day before so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing. Emergency operations are performed with only minutes to do the essential preparations.

Bladder catheters

Female patients usually have a fine rubber tube passed into the bladder through the front passage an hour or two before the operation. This lets the bladder stay empty and small during the operation and helps control your body fluids afterwards.

Male patients will have similar tubing passed in the operating theatre when they are asleep.

Premedication

You may be given a sedative injection or tablets about 1 hour before the operation.

Transfer to theatre

You will be taken on a trolley to the operating suite by a ward nurse and a theatre porter. You will be wearing a cotton gown. Wedding rings will be fastened with tape. Removable dentures will be left on the ward.
There will be several checks on your details on the way to the anaesthetic room where your anaesthetic will begin. You will then go to sleep.
The operation is then performed.
What happens after the operation?
You are unlikely to remember anything for several hours after the operation. You will be taken to the Intensive Therapy Unit on a trolley and will wake up in a bed there.
It is quite likely that you will be connected to an anaesthetic ventilator for a day or two to help you get better. This means that there will be a tube down your mouth passing into your windpipe. The machine will be pumping oxygen in and out for you.
You will not be able to speak because of the tube. But you will be able to hear and see and communicate with the nurses by means of movement. You will have sedatives to help you relax if you need them.
There will be lots of other tubes and wires connecting part of you to various gadgets. For instance, there will be a tube down the back of your nose to keep your stomach empty. There will be a wound drainage tube in the skin of your tummy.
There will be a tube in your bladder to collect urine. This may make you feel that you are wanting to pass urine all the time, but it will pass off.
You will have one or more plastic tubes in the veins of your arms and on the side of your neck to give you liquids. There will be several wires attached to your chest to check your heart action. You will have a cuff on one arm which squeezes automatically every few minutes to measure your blood pressure.
The ventilator is rather noisy, making a pumping noise. There will be several nurses and doctors working around you.
They will talk to you and tell you what is happening, how you are doing, what day it is, what time it is, and what they are going to do next. They will ask you if there is anything you want in the way of pain relief, positioning, seeing relatives, etc.
You will be able to have visitors during this time.
You will have x-rays, physiotherapy and attention to your tubing and wires.
As you get better the various tubes are taken out. After a day or two, you will be able to go back to your original surgical ward without any tubing. By this time you should be starting to drink liquids. You should be on a soft diet within a week and onto a normal diet in two weeks.

Warning after a General Anaesthetic

The drugs we give for a general anaesthetic will make you clumsy, slow and forgetful for about
24 hours. This happens even if you feel quite all right.

For 24 hours after your general anaesthetic:
Do not make any important decisions.

Will it hurt?

Nearly all the pain of the wounds is controlled by a special tube in your back. You can have extra pain killers as needed. You do not have to put up with more than some discomfort.
You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you.
The second day after operation you should be able to spend an hour or two out of bed.
By the end of 4 days you should be comfortable without the special tube in your back.

Drinking and eating

The operation causes the bowel to stop working for a day or two.
Until the bowel starts up again, you will be given water, salts, and sugar solutions into your arm vein.
The first signs of return of bowel activity are noises in your tummy and passing wind out of your back passage. Once these have happened, you will be able to start drinking, a little at a time.
When you are able to drink freely, we take out the arm drip tubing. You should be eating normally after 4 to 5 days.

Opening bowels

It is quite normal for the bowels not to open for 3 or 4 days after operation. If you have not opened your bowels after 4 days and you feel uncomfortable, ask the nurses for a laxative.

Passing urine

Because of the drainage tube (catheter) in the bladder, passing urine is not a problem. Sometimes there is a feeling that there is a leakage all the time. But this is just an irritation by the tubing and it passes off. Once you can walk about in reasonable comfort, the catheter is taken out. If you still cannot pass urine, let the nurses know and steps will be taken to correct the problem.

Sleeping

You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.

Physiotherapy

The physiotherapist will check that you are clearing your lungs of phlegm by coughing. You can help your circulation by continuous movement of body and limbs.

The wound and stitches

Each wound has a dressing which may show some staining with old blood in the first 24 hours. The dressing will be removed and the wound will be sprayed with a cellulose varnish similar to nail varnish. We can take the dressing off after 48 hours. There is no need for a dressing after this unless the wound is painful when rubbed by clothing.
There are no stitches in the skin. The wounds are held together underneath the skin and do not need further attention.
There may be some purple bruising around the wound which spread downwards by gravity and fades to a yellow colour after 2 to 3 days. It is not important.
There may be some swelling of the surrounding skin which also improves in 5 to 7 days.
After 7 to 10 days, slight crusts on the wounds will fall off. The cellulose varnish will peel off and can be assisted with nail varnish remover.
Occasionally minor matchhead sized blebs form on the wound lines, but these settle down after discharging a blob of yellow fluid for a day or so.
The drain tubes are taken out after 3 days.

Injections

You will be given tiny injections into the skin of the tummy twice a day to keep the circulation going.

Washing

You can wash the wound area as soon as the dressing has been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or bathe as often as you want.

What about informing my relatives and contacts?

With your permission, the nurses and doctors will keep your relatives and contacts up to date with your progress.

How long in hospital?

You will probably need 14 days in hospital before you are strong enough to leave hospital.
The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged.
You will be given an appointment to visit the Out Patient Department for a check up about one month after you leave hospital. If you would like convalescence, this can be arranged.

Sick notes

Please ask the nurses for sick notes, certificates etc.

After you leave hospital

You are likely to feel tired and need rests 2 or 3 times a day for a month or two. You will gradually improve so that you should be able to return to your normal level of activity within 3 or 4 months.

Lifting

At first discomfort in the wound will prevent you from harming yourself by too heavy lifting.
After 2 months you can lift whatever you like. There is no value in attempting to speed the
recovery of the wound by special exercises before the 2 months are out.

Driving

You can drive as soon as you can make an emergency stop without discomfort i.e. after about 2 months.

What about sex?

You can restart sexual relations within 2 months or so, when the wound is comfortable enough.

Work

You should be able to return to a light job after about 3 months, and any heavy job within 4
months.

Complications

Complications can occur due to the very size of the operation. They are dealt with by the nurses and doctors. If you think that all is not well, please ask the doctors and nurses.
Bruising and swelling may be troublesome. The swelling may take 4 to 6 weeks to settle down.
Infection is a rare problem and settles down with antibiotics in a week or two.
Aches and twinges may be felt in the wound for up to 6 months.
Occasionally there are numb patches in the skin around the wound which get better after 2 to 3 months.
Occasionally there are lung problems which usually are treated with physiotherapy and antibiotics. Rarely the ventilator is needed for more than a week and in this case a ventilation tube may need to be put into the windpipe via the front of the neck.
Sometimes there are problems with the circulation to the legs, feet or toes. We will discuss this with you .

General advice

The operation may sound complicated, but it is an everyday procedure for us in surgery. If you
have any problems or queries, please ask the nurses or doctors.

Any Questions?

If you have any questions, jot them down here and ask the doctors or nurses for answers.

Any complaints?

If you have any complaints, please contact the doctors or nurses straight away. If this does not solve the problem, please write to me at Ward 3, The Friarage Hospital, Northallerton.

Michael H Edwards
Consultant Surgeon

Acknowledgement

We gratefully acknowledge the generous support for the development and launching of SCALPEL Information Systems for patients, from:

Northallerton Red Cross Society
The crew of the Royal Fleet Auxiliary 'ARGUS'

If you would like to help towards other ventures to benefit patients, please send donations to:

The Chairman
British Red Cross
62 Thirsk Road
Northallerton DL6 1PN
(Please make cheques payable to "British Red Cross")

Have you any comments?

We welcome your comments and suggestions covering your illness, your treatment in hospital, and your recovery. Please write below any points you would like to make. If you prefer, you need not give your name.

Full name:
Hospital:
Ward:
Date of stay in hospital:
Operation:

Out patients department:
Your admission arrangements:
Your welcome on the ward:
Nursing staff:
General ward atmosphere:
Medical staff:
Ward orderlies:
Portering staff:
X-ray staff:
ECG staff:
Did you know who was who?:
Bedding:
Food and drink:
Privacy:
Locker space:
Toilets:
Bathrooms:
Other patients:
Noise:
Information:
Telephone/TV/radio/newspapers:

Timing of operation:
Preparations for your operation:
Going into the theatre:
In the operating theatre:
In the recovery room:
Coming back from theatre:
Intensive Care ward:
Recovery on the ward:
Pain control:
Sleeping:
Wound dressings:
Stitches, clips:
Progress reports:
Visiting hours:
Rest room:
Tablets, medicines, injections:
Going-home arrangements:
Out-patient follow up:
Anything else?

Continue comments overleaf if you wish.

Please send this questionnaire to Mr M Edwards, Friarage Hospital, Northallerton, North
Yorkshire DL6 1JG.