What is Complex Arterial Surgery?
Arteries are blood vessels that carry oxygen-rich blood away from the heart to tissues of the body. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. The aorta divides into a network of smaller arteries that extend all over the body. The arteries' smaller branches are known as arterioles and capillaries. Numerous diseases and conditions can affect the functioning of the arteries increasing your risk of life-threatening events. Complex arterial surgery is a procedure performed for the treatment of complex and serious conditions of the arteries.
Indications for Complex Arterial Surgery
Your surgeon may recommend complex arterial surgery for treatment of conditions that affect your arteries such as:
- Atherosclerosis: A condition in which the arterial wall of the blood vessels is thickened and narrowed due to the deposition of fat or cholesterol forming a plaque. Atherosclerosis in the arteries of the brain, heart, or neck can result in strokes and heart attacks.
- Heart attack: This is also known as myocardial infarction or MI and occurs when the coronary arteries, the blood vessels that supply blood to the heart, are narrowed or blocked. This blockage deprives the heart of blood and oxygen causing damage to the heart muscle.
- Cerebrovascular Accident (Stroke): The brain requires a continuous supply of oxygen and nutrients from the blood in order to function properly. A blockage or rupture of one of the arteries supplying blood to the brain can result in a condition called a stroke. It is a medical emergency that leads to the death of brain cells within minutes of the interruption in blood supply.
- Coronary Artery Disease (CAD): A condition that usually occurs when cholesterol and plaque accumulate inside the coronary arteries (blood vessels supplying oxygen-rich blood to heart muscles) and block the flow of oxygen-rich blood to the heart muscles. The plaque can sometimes break off and form a blood clot that can completely block the vessels, leading to permanent heart damage.
- Carotid Artery Disease: Carotid artery disease occurs due to the deposition of plaque (fatty substances) inside the walls of your carotid (neck) arteries. These arteries supply oxygen-rich blood from the heart to your brain. Due to plaque accumulation, the arteries become narrowed or even completely blocked. This reduces blood flow to your brain and creates oxygen deficiency, increasing your risk of having a stroke.
- Aortic Aneurysm: This is a condition characterised by an abnormal ballooning or bulging of a section of the aorta due to weakness in the wall of the blood vessel. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. An aneurysm can develop anywhere along the course of the aorta.
- Aneurysm that occurs in the section of the aorta that passes through the abdomen is called an abdominal aortic aneurysm.
- Aneurysm that occurs in the part of the aorta that passes through the chest is called a thoracic aortic aneurysm.
- Peripheral Arterial Disease: Also known as peripheral vascular disease, this is a common vascular condition in which blood supply to the lower limbs is reduced due to the narrowing of arteries. This limitation in blood flow to the lower limbs may cause pain or poor wound healing.
Preparation for Complex Arterial Surgery
Preoperative preparation for complex arterial surgery may involve the following steps:
- A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to stop taking blood-thinners, anti-inflammatories, or other supplements for a week or two.
- You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You may be asked to shower with an antibacterial soap prior to surgery to reduce the risk of infection.
- Arrange for someone to drive you home as you will not be fit enough to drive yourself after surgery.
- Informed consent will be obtained from you after the surgery has been explained in detail.
Procedure for Complex Arterial Surgery
Complex arterial surgery may be performed as a traditional open vascular surgery involving a large incision over the area of defect to access the blood vessel to treat conditions pertaining to the arteries or as a minimally invasive endovascular surgery which involves making a small incision instead of a larger incision required for open surgery, and using devices such as a stent and catheter through the blood vessel to repair, unblock, or reroute the blood vessels, often under image guidance. The term endovascular means “inside a blood vessel.” Both open, as well as minimally invasive arterial surgery, is performed under general or local anaesthesia.
Some of the common complex arterial surgeries include:
- Coronary Artery Bypass Grafting (CABG): CABG is a surgical procedure to bypass a blocked artery of the heart. It involves incising a small part of a blood vessel (most commonly a vein from the leg) and using it as a graft (a piece of living tissue that is transplanted surgically). The procedure is indicated for the treatment of narrowing and blockages in the coronary arteries, which can lead to serious complications if left untreated.
- Carotid endarterectomy: Carotid endarterectomy is a surgical procedure performed to treat carotid artery disease and involves the removal of plaque from the carotid arteries of the neck. During the surgery, a small incision is made over the neck to expose the narrowed carotid artery. A plastic tube is placed into the blood vessel, above and below the narrowing or blockage, to re-route the blood flow around the narrowed or blocked area. The artery is then opened, and the plaque is removed. The plastic tube is then removed as normal blood flow has been restored and the artery and skin incisions are closed. The procedure reduces your risk of developing a stroke.
- Peripheral angioplasty with stenting: This procedure is performed to widen the narrowed or blocked peripheral arteries in patients with peripheral arterial disease. The procedure involves passing a catheter (a small hollow tube) through a small incision into the blocked or narrowed section of the artery and inflating a small balloon located at the end of the catheter to push the plaque against the arterial walls to widen the vessel and improve blood flow. Peripheral angioplasty is often combined with the placement of a stent, a small tubular mesh, inside the artery. The stent maintains the patency of the artery and prevents it from future narrowing.
- Aortic Aneurysm Repair: Aortic aneurysm repair can be performed either as an open surgery or as a minimally invasive endovascular surgery, with the minimally invasive technique being the most common approach. During a minimally invasive aortic aneurysm repair, your surgeon makes a small incision in the groin region and guides a catheter (thin tube) through the blood vessel (femoral artery) to the site of the abdominal or thoracic aortic aneurysm to deliver a stent-graft, a tube made of thin metal mesh, under image guidance. The stent-graft is opened in the area of the aneurysm and secured in place for blood to flow through and to prevent the aneurysm from rupture.
- Thrombolytics therapy: Thrombolytics is the use of “clot-busting” drugs to dissolve or break down blood clots formed in blood vessels to prevent damage and death of tissues. It is often used as an emergency treatment for heart attack, pulmonary embolism, and stroke, when clots block blood vessels supplying the corresponding vital organs of the body - the heart, lungs, and brain. The procedure is also indicated to treat blood clots formed in bypass grafts (blood vessels implanted to bypass a blocked artery) and dialysis catheters (catheters implanted for kidney dialysis use). During the process of thrombolysis, clot-busting drugs are administered intravenously (IV) or with the help of catheters (flexible tubes) directly at the site of the blockage. To do this, an incision is made at the groin, wrist, or elbow to access the underlying artery. The catheter is inserted through this incision and threaded to the region of the clot under the guidance of live X-ray imaging (fluoroscopy). Once the catheter reaches the clot, your doctor injects medication to dissolve it.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after complex arterial surgery will involve the following steps:
- You will be transferred to the recovery room where your nurse will closely observe you for any allergic/anaesthetic reactions and monitor your vital signs.
- You may need to stay in the hospital for a couple of days to a week depending on the type of surgical approach.
- You may experience pain, inflammation, and discomfort in the operated area. Medications are prescribed as needed to manage these.
- You are encouraged to move around in bed and walk as frequently as possible to prevent the risk of blood clots.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- Application of ice packs to the operated area is also recommended once the bandage has been removed to reduce swelling and pain.
- Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities, lifting heavy weights, and driving for at least 4 to 6 weeks after the procedure. A gradual increase in activities is recommended.
- You will be advised to take your prescribed medications and make a few lifestyle changes such as quitting smoking, exercising regularly, maintaining a healthy weight, and eating a healthy diet.
- You should be able to return to work in a month’s time and resume your normal daily activities in a couple of weeks, with certain activity restrictions.
- Periodic follow-up appointments will be scheduled to monitor your progress.
Risks and Complications
Complex arterial surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Blood clots
- Allergic/anaesthetic reactions
- Damage to adjacent tissues or organs
- Graft migration
- Heart-related issues
- Damage to kidney