PATIENT INFORMATION COMMON FEMORAL ENDARTERECTOMY THE OPERATION EXPLAINED

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Patient Information –

Patient Information

Common femoral endarterectomy - The Operation Explained

1. Why do I need the operation?

There is a blockage of the artery supplying your leg and the circulation of blood to your leg is reduced. The operation is to remove the fatty deposits (plaque) surgically, through an opening in the artery. This will improve the circulation to your leg.

2. Before your operation

Before surgery, there are a number of tests that may need to be done. These are of two types:

1. Tests of fitness and suitability are normally done before a decision to operate is made. They normally include: blood tests, ECG (electrical tracing of the heart), an ultrasound scan of the blocked artery and/or an X-ray of the arteries (arteriogram).

2. Immediate pre-operative tests include: blood tests, another ECG and completing the paperwork. These tests are usually completed at a pre-admission visit to the hospital a few days before your operation. Occasionally, they are done when you are admitted to hospital for the operation.

3. Coming into hospital

Please bring with you all the medications that you are currently taking. You will be admitted to your bed by one of the nurses who will also complete your nursing record.

You will be visited by the Surgeon who will be performing your operation and also by the doctor who will give you the anaesthetic. Your operation may be performed by a different Vascular Consultant to the one who saw you in clinic.

Physiotherapists and Intensive Care staff may also visit to give you information about your post-operative care. If you have any questions regarding the operation please ask the Doctors.

4. The Anaesthetic

The first part of the operation involves giving you an anaesthetic. The operation can be done with you asleep, or awake:

If you go to sleep, a tiny needle is placed in the back of your hand. The anaesthetic is injected through the needle and you will be asleep within a few seconds.
If you are to be awake, you will have a small tube placed in your back. This may be a spinal or an epidural anaesthetic

A spinal anaesthetic stops you from feeling anything from the waist downward on the operation side. The leg is paralysed. This anaesthetic lasts for about 2-2½ hours.

An epidural again stops you from feeling anything from the waist downwards, and affects both legs. There is no paralysis however. The epidural is like a drip and can stay in for several days to provide post-operative pain relief.

A tube (catheter) may be inserted into your bladder to drain your urine. The catheter is essential if you have either the spinal or epidural anaesthetic.

For all three options, a drip is placed into a vein in your forearm to give you some fluids during and following surgery.

5. The Operation

Normally a cut about 10cm (4inches) long is made in the groin to expose the main artery (Common Femoral Artery) supplying the leg.

The plaque is removed and the artery is closed using a patch of vein or synthetic material.

At the end of the operation, the wounds are all closed either with dissolving stitches, which do not need to be removed, or with a non-dissolving stitch or metal clips which will normally be removed after about ten days.

6. 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.

The nurses and doctors will try and keep you free of pain by giving pain killers by injection, via the epidural tube in your back or by a machine that you are able to control yourself by pressing a button (PCA – patient controlled analgesia).

Within a day or so, the drip, epidural and bladder catheter will be removed.

You will become gradually more mobile until you are fit enough to go home.

You may be visited by the physiotherapists after your operation. They will help you with your breathing to prevent you developing a chest infection and with your mobilisation to get you walking again.

7. Going home

After this type of surgery, patients normally return home about 5 days after the operation.

If your stitches or clips are the type that needs removing, this is usually done whilst you are still in hospital. If not, we will arrange for your GP’s practice or district nurse to remove them and check your wound.

You may feel tired for some weeks after the operation but this should gradually improve as time goes by.

Regular exercise such as a short walk combined with rest is recommended for the first few weeks following surgery followed by a gradual return to your normal activity.

Driving: You will be safe to drive when you are able to perform an emergency stop. This will normally be 2-4 weeks after surgery, but if in doubt check with your own doctor.

Bathing: Once your wound is dry you may bathe or shower as normal.

Work: You should be able to return to work within 6-12 weeks of surgery. We will provide you with a sick note but if you need longer off work, please see your GP.

Medicines: You will usually be sent home on a small dose of aspirin if you were not already taking it. This is to make the blood less sticky. If you are unable to tolerate aspirin, an alternative drug may be prescribed.

8. Complications

Thrombosis and embolism (clotting of the artery) at the surgical site or beyond it. If this occurs, it is usually necessary to perform a second operation to re-open the artery.
Wound infection: Wounds sometimes become infected and this may need treatment with antibiotics. Bad infections are rare. Occasionally, the wound may need to be cleaned out under anaesthetic.
Fluid in the wound: Occasionally, the wound may fill with fluid (lymph). This may be clear but is often blood stained. It normally settles in time but may require suction (aspiration) to help remove the fluid.
Skin sensation: You may have patches of numbness around the wound due to the inevitable cutting of small nerves to the skin. This usually gets better within a few months.
Chest infections: These can occur following this type of surgery, particularly in smokers, and may require treatment with antibiotics and physiotherapy.
Major complications: As with any major operation there is a small risk of you having a medical complication such as a heart attack, stroke, kidney failure, chest problems, loss of circulation in the legs or bowel or infection in the artificial artery. Each of these is rare, but overall it does mean that some patients may have a fatal complication from their operation. For most patients this risk is about 5% - in other words 95 in every 100 patients will make a full recovery from the operation. The doctors and nurses will try to prevent these complications and to deal with them rapidly if they occur.

9. What can I do to help myself?

If you were previously a smoker, you must make a sincere and determined effort to stop completely. Continued smoking will cause further damage to your arteries. It is also likely to jeopardise the success of any surgical operation carried out and to make recovery more difficult.

Why not take this opportunity to consult your own doctor or the practice nursing staff to seek professional help in giving up the addiction?

Further help is available locally from the

Smoking Advice Service Tel: 01752 314040 www.smokingadvice.com

General health measures such as reducing weight, a low fat diet and regular exercise are also important. If you develop sudden pain or numbness in the leg which does not get better within a few hours, then contact your GP or the hospital immediately.

Vascular patients are known to be at increased risk of heart attack and stroke. You should talk to your doctor about taking low dose Aspirin or an alternative anti-platelet agent in order to thin the blood and to help reduce the likelihood of developing a heart attack or stroke. In addition, your doctor may advise taking a statin, which will reduce your cholesterol level, further decreasing these risks.

PATIENT INFORMATION COMMON FEMORAL ENDARTERECTOMY THE OPERATION EXPLAINED

Version November 2014

VASCULAR SURGICAL UNIT

SURGICAL DIRECTORATE

PLYMOUTH HOSPITALS NHS TRUST

DERRIFORD HOSPITAL

PL6 8DH

TEL 0845 155 8155

CONSULTANT VASCULAR SURGEON & LEAD CLINICIAN

Surgeon Commander Cris Parry RN

Secretary: 01752 431809

CONSULTANT VASCULAR &

TRANSPLANT SURGEON

Mr Jamie Barwell

Secretary: 01752 431809

CONSULTANT VASCULAR SURGEON

Mr Francis Dix

Secretary: 01752 431822

CONSULTANT VASCULAR SURGEON

Miss Catherine Western

Secretary: 01752 431805

CONSULTANT VASCULAR SURGEON

Mr Devender Mittapalli

Secretary: 01752 431822

CONSULTANT VASCULAR SURGEON

Lt Col Robert Faulconer

Secretary: 01752 431805

VASCULAR SCIENTISTS

Mrs J George

Mr A Ellison

Mr R Craven

01752 439228

VASCULAR NURSE SPECIALIST

Mr Alan Elstone

01752 431805

MATRON

Judy Frame

01752 431847

PATIENT INFORMATION COMMON FEMORAL ENDARTERECTOMY THE OPERATION EXPLAINED

Patient information –Common femoral endarterectomy

TREAT PATIENTS IN A CLEAN AND SAFE ENVIRONMENT
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