Having surgery

There are a number of ways you can improve your health before your surgery. 

Smoking

If you are a smoker, the most important thing you can do to help yourself is to give up smoking. This will also help to protect all of your arteries, making it less likely that you will have heart attacks or strokes.

Giving up is not easy but there is a smoking cessation service and support groups that can help. Your vascular specialist nurse or GP practice nurse can advise you about these. If you would like to stop smoking, please speak to your nurse. Or call our stop smoking service, phone: 020 7188 0995, or call the NHS Smoking Helpline, phone: 0300 123 1044

Activity

Gentle exercise, such as walking and cycling, is recommended to help improve your overall level of fitness. Exercise helps your body to produce healthy cholesterol and this helps to protect your arteries against bad cholesterol. Exercising may be difficult if you suffer with claudication, however it is important to keep as active as you can.

Blood pressure

It is very important that you have your blood pressure checked regularly, at least every 6 months. If you have been prescribed medicines for high blood pressure, you must make sure that you take it according to the instructions given.

Diabetes

If you have diabetes, it is important that your blood sugar levels are well controlled.

Blood cholesterol (fatty substance in your blood) levels

You should eat a healthy, balanced diet and try to reduce any excess weight. It is important to reduce the level of cholesterol in your blood. Your vascular nurse can refer you to a dietitian if needed. You might be prescribed medicine to help lower your cholesterol (for example, a statin), and low dose aspirin to help prevent blood clots from forming.

Weight

There are increased risks when having an anaesthetic and the operation if you are overweight, so losing weight and having a healthy diet will help reduce these risks. Your GP may be able to refer you to a dietitian if you need help.

Pre-assessment

You will usually be seen in a pre-assessment clinic and they will carry out a number of tests to help assess your general fitness for surgery. 

Some people may also be assessed by the POPS (proactive care of the older person undergoing surgery) team, who will carry out a comprehensive medical and social assessment. 

You will usually have the following tests, but not all be required: 

• blood tests
• electronic heart monitoring (ECG)
• echocardiogram (an ultrasound scan of the heart)
• breathing test – spirometry or peak flow
• chest X-ray
• MRSA swabs 

The results of these tests will help your doctor to make a decision on whether you should have the operation. 

Your medicines

At your pre-assessment or POPS appointment, your regular medicines will be reviewed and we will let you know if you need to temporarily stop any medicines before your surgery. 

Tell us if you are taking medicines that slow your blood clotting (sometimes known as blood thinners), such as antiplatelet medicines (for example, aspirin or clopidogrel), or anticoagulant medicines (for example, warfarin or rivaroxaban). We will tell you if you need to stop them temporarily before your surgery. 

If you are taking medicines for diabetes (for example metformin) or using insulin, the dose may need to be altered near the time of your procedure. Please ask us if you have any questions.

Stopping food and drink before surgery (fasting)

We will also send you information about fasting, which is usually for 6 hours before surgery. Fasting means that you cannot eat or drink anything (except water). We will give you clear instructions on whether you need to fast and when to start fasting. It is important to follow these instructions. If there is food or liquid in your stomach during the operation, it could come up to the back of your throat and damage your lungs. 

You can take your regular morning medicines with a sip of water before 6am on the morning of the procedure, unless you have been told otherwise.

On the day of surgery

You will be having your surgery under general anaesthetic. This means that you will be asleep during the operation and will not feel any pain. An anaesthetist will see you before your surgery to ask about your health, and explain the different ways pain can be prevented and controlled after your surgery.

Read our information about having a general anaesthetic.

After surgery

You will wake up in the recovery area, where you will be monitored until you are ready to be moved to a ward. 

If you need additional monitoring, you may spend the night in overnight intensive recovery (OIR) or a high dependency unit (HDU). 

If you have had an axillo-bifemoral bypass, you will be given something to eat and drink after the operation. 

If you have had an aorto-bifemoral bypass, then you will be gradually reintroduced to food and drink over the next few days. 

Following this sort of surgery, the bowel may stop working for a short while (this is called ileus). You will be given all the fluids you need via a drip until your bowel can cope with fluids by mouth. You will have a tube in your bladder (a urinary catheter) for a day or so. This can be removed when you are able to get up and go to the toilet or when you have had a poo (opened your bowels).

Getting mobile

A physiotherapist will see you every day from the first day of your operation, possibly including the day of the operation itself. A physiotherapist will help you regain your normal mobility. Being mobile is important in preventing muscle deconditioning and blood clots. You will be encouraged to do deep breathing exercises to prevent chest infections. 

You can expect to be allowed home about 5 to 7 days after your surgery.

Pain

You may also have a small tube placed in your back called an epidural, which will help deliver pain relief after surgery. 

Or you may be given pain relief by a machine (pump) that delivers painkillers directly into your vein through a drip. The machine allows you to control the dosage yourself by pressing a button. The anaesthetist will discuss this with you. 

You may be tender at the wound sites for a few days after the procedure, and you will be prescribed painkillers for as long as they are required.  

Leaving hospital

Your dressing will usually be removed before you leave hospital. If you still need a dressing when you go home, we will arrange for a practice nurse at your GP surgery or a district nurse to change it regularly.

If your stitches or clips are the type that need removing, we will arrange for your GPs surgery’s practice nurse, or a district nurse to visit to remove these. 

It is fine to have a shower when you go home.

Follow-up appointment

After you have left hospital, you will receive an appointment to see your surgeon about 6 weeks later. This will be organised in your local hospital where possible.