Surgery of the Aorta
Arterial Bypass and Endarterectomy
There are two types of blood vessels in the
body – arteries and veins. Arteries carry
blood rich in oxygen from the heart to all the
organs of the body. Veins carry blood back
to the heart. The aorta is the largest artery in
the body. It is also the most important blood
vessel. If there is a problem with your aorta
or arteries, the blood flow to the rest of your
body is decreased.
There are two types of arterial disease:
atherosclerosis and aneurysm.
With atherosclerosis, the walls of the
arteries are narrowed because of plaque
build-up. This can form a blockage. This
occurs slowly over time. The plaque is
made up of fat, cholesterol and calcium
deposits. It can result in less blood flow to
your legs and other organs.
Surgery can help bypass or remove the
blockage. This will increase the blood flow
to your legs and other organs. The surgery to
bypass the blockage in the lower aorta is
called an aortobifemoral bypass. If the
blockage is removed, it is called an
An aortic aneurysm is a weakened part of
the artery. It looks like a bulge or balloon in
the wall of the vessel. It can occur in the
part of the aorta that is in the chest or in the
abdomen. In the abdomen, it is called an
abdominal aortic aneurysm (AAA). If it is
in both the chest and abdomen, it is called a
thoraco-abdominal aneurysm (TAA). It also
can occur in the iliac, femoral or popliteal
arteries. If the aneurysm bursts or tears, it
can cause life-threatening bleeding.
Blood clots can also form in aneurysms or
stick to the wall of the arteries causing
atherosclerosis. These blood clots can break
off and get stuck in the artery and block
blood flow. This is called an embolus.
Risk Factors for Atherosclerosis
ξ High blood pressure
ξ High cholesterol
ξ Lack of exercise
ξ Family history
ξ Irregular heartbeat, especially atrial
fibrillation (a heart condition where
the heart chambers quiver and beat
Symptoms of Peripheral Arterial Disease
ξ Leg pain that is relieved with rest
ξ Pain at rest, if blockage is severe
ξ Discolored skin
ξ Legs are cool to touch
ξ Loss of hair on toes, feet and legs
ξ Thick toenails
ξ Numbness and tingling
ξ Male impotence
Symptoms of Aneurysm - you may not
have any symptoms but these may be
ξ Back pain
ξ Abdominal pain
ξ Chest pain (thoracic aneurysm)
ξ Pulsating feeling in abdomen
ξ Discolored feet
Routine tests will be done to diagnose your
blood vessel disease. They may include:
ξ Computerized Tomography (CT)
or Ultrasound: shows that a blood
vessel is narrowed or blocked.
ξ Angiogram: an x-ray that can
pinpoint a blockage or aneurysm in
ξ Magnetic Resonance Angiogram
(MRA): an imaging technique that
uses a strong magnet, radio signal,
and a computer to produce pictures
of the blood flow from your arteries.
ξ Ankle Brachial Pressure Index
(ABI): The ABI test uses sound
waves to measure the blood pressure
in your arms and ankles using a
small, hand held device called a
Doppler. It is done to check for
peripheral arterial disease.
Treatment to fix a blockage depends on the
extent of your disease and your health. Mild
disease may improve with:
ξ Control of risk factors
ξ Balloon angioplasty or stenting
Surgery can help bypass or remove the
blockage. This will increase the blood flow
to your legs. If plaque is removed, it is
called an endarterectomy. If a blood clot is
removed for the artery or bypass graft, it is
called an embolectomy or thrombectomy.
Placement of a bypass graft around a
blockage is the most common surgery done
to improve the blood flow in your leg. A
vein from your leg or arm may be used to
bypass the blockage or aneurysm. It is
called a bypass because the graft will send
blood around the blockage. A fabric graft
will be used if one of your own veins can’t
be used. It is sewn to make the wall of the
Surgery to fix an aortic aneurysm or
blockage in the aorta or other artery is done
under general anesthesia. This means you
will be asleep during surgery. This type of
surgery takes 3-6 hours. Based on the site of
your disease, your surgeon will make an
incision into either your chest or your
abdomen. If you are having an
aortobifemoral bypass, you will have an
incision in your abdomen and in each side of
What to Expect before Surgery
You will not be able to eat or drink anything
for at least 6 hours before your surgery. The
night before your surgery you may need to
have a bowel prep to clear your bowel out
for surgery. You will be told whether to do
What to Expect during Surgery
Surgical techniques include:
ξ Endarterectomy or removal of the
plaque. The plaque is cut from the
blood vessel wall.
ξ Embolectomy or removal of a blood
ξ Placement of a bypass graft around a
blockage or aneurysm. This is often
used to treat arterial disease in the
leg. A vein from your leg or arm
may be used to bypass the blockage
or aneurysm. A fabric graft will be
used if one of your own veins can’t
be used. It is sewn to make the walls
of the aorta stable.
The incision is then closed with staples or
stitches. A dressing is put over your closed
What to Expect after Surgery
After surgery you may be moved to an
intensive care unit (ICU) or to an
intermediate care unit (IMC). We will
closely watch your heart rate, blood
pressure, and blood oxygen level. If you are
moved to an ICU, you will be moved to a
standard hospital room 1-3 days after
When you wake up you will have some
tubes and lines attached to you.
ξ Breathing Tube: You may have this
at first to help you breathe. It will be
taken out when you can breathe on
ξ Intravenous Line (IV): This will be
in your arm or neck for medicine and
ξ Arterial Line: This is in the artery
in your wrist and is used to measure
your blood pressure and draw blood.
ξ Foley catheter: This is a catheter
that will be in your bladder to drain
ξ Other tubes or lines: You may have
other drains either in your stomach,
your incision, or your spine. You
will be given medicine to help
manage your pain.
You may have blood tests, x-rays,
ultrasounds or other procedures. You may
also need to wear compression stockings.
They help prevent blood clots in your legs.
You will not be able to eat or drink for a few
days. You will slowly be able to eat more
each day. As you recover, you will work
with nurses and physical therapists to get
your strength back.
Most patients who have this surgery can go
home within 5-7 days.
Your incision is closed with stitches or
staples. You will receive instructions before
you are discharged home.
ξ You may get it wet in the shower.
ξ Do not swim or take tub baths until
okayed by your doctor.
ξ You may clean the incision gently
with mild soap and water. Remove
any dried drainage. Do not scrub the
incision. Rinse it and pat dry.
ξ Do not use any lotions, alcohol or
powders until told by your doctor.
ξ Most incisions can be left open to air
except for incisions in the groin.
These should be covered with a dry
gauze dressing. Be sure your
incision is dry before you apply the
At your first clinic visit after discharge, your
staples or stitches may be removed. Small
pieces of tape called Steri-Strips® may be
placed to keep your incision closed.
ξ You may shower with the Steri-
Strips® in place. Allow the water to
flow gently over the area. Do not
rub. Gently pat dry.
ξ After 2-3 days, they will begin to
curl up at the ends.
ξ With time, they will fall off on their
ξ Do not swim or take tub baths until
your doctor says it’s okay.
When you go home you should be able to do
most of your basic daily routines. You will
need to give yourself time for rest. You will
tire easily. You may feel weaker. This is
normal. Your strength and energy level
will increase as your body heals.
Walking is good for you. Start slowly and
increase your distance a little bit each day.
This will help you become stronger.
Walking also helps prevent constipation and
blood clots. If your legs swell, raise your
legs when sitting.
You will have some restrictions. For the
first few weeks after surgery:
ξ Do not life more than 10 pounds
during the first 6 weeks at home.
This includes groceries, pets and
children. One gallon of milk weighs
about 8 pounds.
ξ Do not drive until your doctor says it
is okay. Do not drive while taking
narcotic pain medicine.
ξ Do not play contact sports or do
exercise other than walking until
your doctor approves.
ξ Ask your doctor at your first clinic
visit when you may return to work
and resume sexual activity.
ξ If you had an aortobifemoral bypass,
you should not sit for longer than 1
hour at a time. Be sure to elevate
your legs when sitting.
It is normal to have some pain at your
incision. You may also have pain in your
belly, chest, back or groin. The pain will
decrease as the incision heals. You should
take the pain medicine prescribed by your
doctor. As time passes, you should need
less pain medicine. You may then wish to
use an over-the-counter pain medicine but
talk to your doctor before starting this. It
may interfere with other medicines you are
taking. Do not drive while taking narcotic
Narcotic pain medicine can make you
constipated. Use over-the-counter stool
softeners (Senna/Docusate) as needed.
Drink plenty of fluids and eat high fiber
foods. Fruits and vegetables (prunes,
raisins, apples, oranges, potatoes, spinach
and carrots) and whole grain breads or rice
have fiber. Staying active also helps prevent
You may have loss of appetite and even lose
weight. You should still try to eat because a
healthy diet helps your body heal. You may
want to eat small amounts of food several
times a day instead of eating three large
You should also drink enough fluid to stay
hydrated. Dehydration can make you feel
more tired and weak. Drink at least 8 to 10
eight-ounce glasses of fluid each day. Water
and milk are good options. Limit the
amount of drinks with caffeine (soda,
coffee) because they can dehydrate you.
Eat a heart healthy diet:
ξ Eat less saturated fat. Eat less fatty
meats, fried foods, butter and whole
milk dairy products. Eat more fish,
chicken, turkey and veal and less
beef, lamb and pork.
ξ Limit eating organ meats (liver,
kidneys, etc) to once a month.
ξ Use polyunsaturated oils, such as
canola, safflower, soybean,
sunflower, sesame and cottonseed
ξ Drink skim milk instead of whole
ξ Eat sherbet or Italian ice instead of
ξ Eat less trans fats. Eat fewer
sweets such as donuts, cookies, and
ξ Eat fewer carbohydrates. Eat less
sugars and sweetened drinks.
ξ Eat less salt. Eat less processed
foods. Do not add extra salt to your
ξ Eat less cholesterol. Eat less egg
yolks and shrimp.
If you have an artificial graft, you will need
antibiotics before any future surgery. You
will also need them before certain dental
procedures, and other invasive procedures
(colonoscopy, etc.). Tell your dentist or
doctor about your artificial graft so you can
get antibiotics. This may prevent a graft
As you become more active, your legs may
swell. If this happens, raise your legs when
you sit. Your doctor may want you to wear
anti-embolism stockings or ace bandages
when you go home. These help reduce
swelling and return blood to the heart.
Apply them before walking. If you wear ace
bandages, they should be wrapped snugly
from toe to knee. Your nurse will show you
how to wrap them. Remove them when you
go to bed.
You may need to wear stockings or ace
wraps for the first 2 weeks, or until the
swelling is gone. If you are still having
swelling, keep wearing them for support.
Ask your doctor when you can stop wearing
Do not wear clothes that constrict your legs
or feet such as tight socks or garters. Buy
shoes that fit well to prevent pressure sores
or swelling in your feet. Wear socks with
your shoes to prevent blisters.
Leg and Foot Care
To help prevent foot problems, follow these
ξ Look at your legs and feet daily. If
you can’t see them, have someone
else check them. Let your doctor
know if you see any sores, scratches,
cracks, blisters or reddened areas.
ξ Wash your legs and feet daily with
mild soap and water. Do not soak
your feet. Dry them well.
ξ Put lotion on dry skin daily. Do not
put lotion between your toes.
ξ Avoid soaking your feet for long
periods. It dries out your skin.
Always check the temperature of the
water with your hand or elbow
instead of your foot.
ξ Let a doctor or nurse clip your
toenails or show you how to clip
ξ Wear shoes that fit well.
ξ Wear white cotton or wool socks.
ξ Check shoes and socks for stones,
sharp things, or holes.
ξ Protect your feet from extreme heat
ξ Avoid walking barefoot.
ξ Do not use heating pads or heat
lamps on your feet or legs.
ξ See a podiatrist if you need corns,
calluses or ingrown toenails
Try to quit smoking. Smoking delays wound
healing, and can decrease blood flow, shrink
arteries, and raise your blood pressure. If
you’d like help quitting, call the Quit Line:
You will be seen in the Vascular Surgery
Clinic about 2 weeks after you go home. If
you still have staples or stitches, they may
be removed at this visit.
When to Call the Doctor
ξ An increase in redness or warmth at
the site of your incision.
ξ Red streaks on your skin that extend
from the incision.
ξ Bulging or swelling at the incision.
ξ New drainage or bleeding from your
incision. Call if drainage is cloudy,
yellow, green or foul-smelling.
ξ Open spots between the stitches or
staples where the skin is pulling
ξ If you notice the skin along the
incision is getting darker or turning
ξ Sudden increase in pain that is not
relieved by your pain medicine.
ξ A temperature of more than 101.5 θF
(38.5 θC) by mouth for two readings
taken 4 hours apart.
ξ A new onset of weakness or
numbness in your legs or feet.
ξ Cold or discolored legs.
ξ Numbness, tingling or loss of
movement in your legs.
ξ Sudden increase in tenderness or
swelling in your leg.
Vascular Surgery Clinic at (608) 263-8915
from 8:00 am to 5:00 pm Monday through
After hours, your call will be answered by a
paging operator. Ask for the Vascular
Surgery doctor on call. Give your name and
phone number with area code. The doctor
will call you back.
If you live out of the area, call
Fahey, Victora A. 4th E. Vascular Nursing.
Philadelphia: WB Saunders Co., 2004.
Your health care team may have given you this
information as a part of your care. If so, please use it
and call if you have any questions. If this information
was not given to you as a part of your care, please
check with your doctor. This is not medical advice.
This is not to be used for diagnosis or treatment of
any medical condition. Because each person’s health
needs are different, you should talk with your doctor
or others on your health care team when using this
information. If you have an emergency, please call
911. Copyright © 10/2016 University of Wisconsin
Hospitals and Clinics Authority. All rights reserved.
Produced by the Department of Nursing. HF#7571