Download Abdominal Arterial Disease

Circulating the Facts About
Peripheral Vascular Disease
Abdominal
Arterial Disease
Brought to you by the Education Committee
of the Society for Vascular Nursing
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Circulating the Facts About Peripheral Vascular Disease
Abdominal Arterial Disease
This booklet will give you and your family information about abdominal arterial
disease and its treatment.
Many people will be involved in the diagnosis and treatment of this disease, but
you are the most important. Physicians, nurses, and vascular technologists will
be evaluating the condition of your blood vessels, planning your treatment, and
explaining test results and surgery. You play a key role in controlling your
disease by changing certain habits or risk factors.
The information in this booklet:
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Identifies the blood vessels involved
Describes blood vessel disease of the abdominal arteries
Provides information about treatment, surgery, and self-care after discharge
from the hospital
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Boldface type is used to point out words that may not be well known.
These words are defined on the last pages of this booklet.
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What Is
Abdominal Arterial Disease?
Normally, the lining of the artery is smooth and blood flows easily through it.
When atherosclerosis (hardening of the arteries) develops, the lining of the
artery becomes rough and thickened by a build up of plaque or the artery wall
becomes thin and enlarges like a balloon. The first type is called occlusive
disease. The second is called aneurysmal disease. Changes that occur in the
blood vessels from occlusive or aneurysmal disease do not occur overnight but
develop over many years. People usually do not start to have symptoms of
disease until their middle years. For men, this is approximately 45 years of age,
and for women 55-60 years of age.
Examples of Normal and Occlusive Diseased Arteries
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What Treatments Are Available For
Abdominal Arterial Disease?
The treatment for abdominal arterial disease depends upon your general
condition, your signs and symptoms, results of your tests, and the physician’s
recommendations. Arterial disease is helped by:
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Eliminating the use of tobacco
An exercise program
Medication
A low fat diet
More severe occlusive arterial disease may also be treated by a vascular
radiology procedure or by surgery. Treatment of an aneurysm will depend on
the size, location, and rate of growth. Generally, aneurysms less than 5 cm will
be monitored regularly for growth. It is extremely important that you keep your
scheduled follow-up visits to monitor for changes, as it is unlikely that you
would experience any symptoms unless the aneurysm ruptures. A ruptured
aneurysm requires immediate emergency surgery. Signs of a rupture include
severe back and or abdominal pain, weakness and loss of consciousness.
Your physician and nurses will explain your options and your care. You are
encouraged to ask questions if anything is unclear.
Vascular Radiology:
Procedures Involving an Arteriogram
The following procedures may be used during an arteriogram, or in combination
with surgery for various stages of disease.
BALLOON ANGIOPLASTY
This procedure may be used for short areas of blood vessel narrowing. (A) A
small tube or catheter, with a balloon at the end of it, is placed in the artery at
the area of narrowing. (B) The balloon is inflated and breaks the plaque against
the inner wall of the artery making more room for blood flow. (C) The balloon
is then deflated and the catheter is removed. (D) Dye is injected to determine
if the artery has opened adequately. If not, the procedure is repeated.
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STENTING
Stenting involves insertion of a small wire coiled mesh into the artery over the
site of the balloon angioplasty. The stent is opened by the balloon and holds
the compressed plaque open to allow more blood to flow through the artery.
THROMBOLYTIC THERAPY
In this procedure, special medication is given through a blood vessel to dissolve
recent blood clots. The medication may be given over several hours to a few
days to dissolve the clot if possible. X-rays are taken regularly to see if the clot
is dissolving.
ATHERECTOMY
A small catheter with a cutting blade is introduced into an artery. The blade
cuts into the plaque at high speed and small pieces of the plaque are removed.
This procedure can be done using injection of dye, with a balloon angioplasty,
or during surgery.
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What Surgery Is Available For
Abdominal Arterial Disease?
Surgery is performed on the aorta and its branches to improve circulation to
the legs, kidneys, and the intestines. Surgery may involve removing the plaque
known as endarterectomy, removing the blood clot from a blocked artery
known as thrombectomy/embolectomy, or bypassing the diseased artery. The
physician and nurse will be able to describe your operation and answer your
questions.
ENDARTERECTOMY
This surgery involves opening the diseased artery, removing the plaque, and
closing the opening with sutures. This is considered major surgery and may
take several hours depending upon which artery is involved and how much
disease is present.
THROMBECTOMY/EMBOLECTOMY
This surgery involves removing a blood clot from an artery. A small catheter,
with a balloon at the end of it, is positioned in the artery past the clot. The
balloon is then inflated and the catheter is pulled back through the artery,
taking with it any blood clot. The artery opening is closed with sutures.
BYPASS
One of your veins or a synthetic (man-made or replacement) graft is used for
abdominal arterial disease surgery. The graft will bypass an area of narrowing/
blockage, or replace the weakened walls of an aneurysm. Blood flow resumes
normally through the bypass graft to the legs, kidneys, or intestines. Synthetic
grafts are not rejected by the body, but can become infected.
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What Are Some Examples of Surgery For
Abdominal Arterial Disease?
The following pages will show pictures of some of the common surgeries done
for abdominal arterial disease. These are set up in four sections that have colorcoded pages for easy location. The following are the four sections with their
color-coding and the surgeries shown for each section.
Aneurysmal Disease of the Aorta and Iliac Arteries (Pages 8-9)
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Aortic Tube Bypass
Aortoiliac Bypass
Aortofemoral Bypass
Endovascular Aortic Stent Graft
Occlusive Disease Affecting Blood Flow To the Legs (Pages 10-13)
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Aortoiliac Endarterectomy
Aortoiliac Thrombectomy/Embolectomy
Aortofemoral Bypass
Axillofemoral to Femoral-Femoral Bypass
Occlusive Disease Affecting Blood Flow To the Kidneys (Pages 14-15)
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Aortorenal Endarterectomy
Aortorenal Bypass
Occlusive Disease Affecting Blood Flow To the Intestines (Page 16)
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Aortomesenteric Bypasses
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Aneurysmal Disease of the Aorta
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Aneurysmal Disease of the Aorta and Iliac Arteries
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Occlusive Disease Affecting Blood Flow To the Legs
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Occlusive Disease Affecting Blood Flow To the Legs
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Occlusive Disease Affecting Blood Flow To the Legs
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Occlusive Disease Affecting Blood Flow To the Legs
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Occlusive Disease Affecting Blood Flow To the Kidneys
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Occlusive Disease Affecting Blood Flow To the Kidneys
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Occlusive Disease Affecting Blood Flow To the Intestines
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Getting Ready For
Endovascular Aortic Stent
Graft Repair
An endovascular stent graft is a polyester graft either covered by or
surrounded by a stent, a small metal coil. The stent is compressed before
placement and self-expands when entered into the blood vessel, or it is opened
by a balloon inflation. As in the surgical repair of the aneurysms, stent grafts
are placed to minimize the risk of the aneurysm rupturing.
Generally, before an endovascular aortic stent graft procedure, one or more
diagnostic tests are required to obtain the information necessary for the
procedure to be accomplished. A CT scan, MRI, and/or Intravascular
Ultrasound (IVUS) can provide specific measurements of the aneurysm size,
shape and location. Sometimes an arteriogram will need to be done to
determine the extent of the circulation to the intestines, kidneys, and legs.
What Should Be Expected in
Endovascular Aortic Stenting?
You will have an incision in one or both groins. This procedure can be done
under local, spinal, and/or general anesthesia. You may be given a laxative prior
to the surgery. The physician will discuss all of the potential complications of
the surgery, including those which may lead to changing from stent graft
placement to standard surgical repair of your aneurysm.
The physician placing the stent graft may inject contrast dye into the aorta to
determine whether the stent has sealed off the aneurysm completely. You will
be in the hospital approximately 2-3 days before discharge. Some patients
experience flu-like symptoms in the first day or two after the stent graft is
placed. This feeling is believed to be related to the body’s inflammatory
reaction to the stent graft.
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Following the
Endovascular Stent Graft
Repair
The physician will generally do a follow-up exam with either an abdominal
ultrasound or a CT scan to determine whether there is any change in the
placement of the stent or leakage around the stent.
Report the following to your physician:
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Swelling and/or drainage from the incisions
Fever
Pain in your legs while at rest
New toe discoloration or coldness
Abdominal or back pain
Change in bowel habits
Getting Ready For
Surgery
The day before or the day of surgery, you may be asked to take a shower with
special soap. You may be given fluid by vein (IV) starting the evening before or
the morning of the surgery. To prepare your stomach and intestines for surgery,
the physician may order a special diet, an enema, and/or a laxative. You will be
instructed in deep breathing, coughing, and possibly other breathing exercises
and leg/ankle exercises to improve blood flow during the first days after the
surgery.
If you smoke, you are advised to stop at this time. The morning of surgery, you
will need to wear a hospital gown and remove any jewelry, glasses, nail polish,
make up, and/or dentures. The nurse may give you an injection to help you
relax and you may feel drowsy. Empty your bladder before the medication is
given; then remain in bed. Soon, you will be taken to the operating room on a
stretcher. If you have family or friends with you, the nurse can direct them to
the waiting room. Abdominal arterial surgery usually takes several hours.
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After Surgery
After surgery, you will be taken to the Recovery Room or Intensive Care Unit.
You may be on a ventilator (breathing machine) to assist you in taking deep
breaths. It is routine for the nurses to frequently check your blood pressure,
heart and breathing rates, the area of surgery, and the pulses in your feet and
groin. A soft pad or padded booties may be used to keep your feet warm and
prevent heel sores.
You will be asked to turn, cough, and take deep breaths while you are in bed in
order to prevent problems such as pneumonia. It may be painful to cough and
deep breathe with an abdominal and/or groin incisions. Splinting with a pillow
and requesting pain medications on a regular basis will enable you to do this
more comfortably. You may have a machine whereby you can give yourself
pain medicine through your IV when you need it. This is called Patient
Controlled Analgesia (PCA).
You may have pain medicine for anesthesia given to you through a catheter in
your back that was placed at the time of your surgery. Leg and ankle exercises
done on a regular basis will help to improve blood flow and prevent blood clots
from forming while you are recovering from surgery. The physician may order
support stockings or stockings that compress and release pressure that is
controlled by a machine to aid venous return and prevent blood clots.
Your diet and activity will depend on the physician’s orders. Often surgeries
done for abdominal arterial disease cause the stomach and bowels to slow down
for a few days. You may have a nasogastric (NG) tube to keep the stomach
empty and prevent nausea and vomiting. This tube is passed through your nose
and into your stomach and taped in place while you are in surgery. You will
receive fluids by vein until your bowels begin to work again. Then the NG tube
can easily be removed, and you can begin to drink and eat again. Usually your
diet will start with liquids and gradually advance to solids.
You may have a catheter in your bladder to monitor your urinary output for a
few days. Your weight will be checked. People will often gain several pounds
of water weight during the surgery that will be lost over the next few days.
As you recover, you will be able to increase your activity each day. The length
of time you will be in the hospital varies, but is usually 5-10 days. If sutures or
staples were used to close the incisions, they will be removed before you leave
the hospital, or a few days later in the physician’s office. If you have had an
Axillofemoral Bypass, the physician or nurse will discuss specific things to be
aware of.
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Care At Home
You may feel weaker and more tired at home, and it is common to have
decreased appetite, some weight loss, and incisional discomfort after abdominal
arterial surgery. This is normal, and it may take several weeks for you to feel
like yourself again. As you resume your usual activities, allow for rest periods.
If you live alone, you might consider household help or staying with friends or
relatives until you are stronger.
Incisions
There are several layers of stitches on the inside holding your wound together
that will stay in place permanently. You may shower and gently clean the
incision with soap and water and pat yourself dry 2-3 days following the
procedure. Small pieces of tape called steri-strips may be placed along the
incision at the time the sutures/staples are removed. You can shower with
these in place. Steri-strips help to support the incision for a few days and
usually begin to peel away after 5-7 days and can then be pulled off. Avoid
creams, powders, or lotions on your incision immediately after surgery unless
otherwise advised by the physician.
Activity
Check with the physician for any activity restrictions. Walking is good because
it strengthens your muscles and improves blood flow. It is important that your
walking program progress gradually. Avoid lifting anything heavier than 5-10
pounds during the first six weeks at home. This will allow time for the muscles
and incisions to heal. Avoid sitting for more than 1-2 hours without getting up
and walking around for a while. Refrain from crossing your legs since this can
slow blood flow.
Driving
Your ability to respond quickly may be impaired as you recover from surgery
and especially if you are taking pain medications. Do not drive a car until you
have permission from the physician, usually after the first office visit.
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Foot Care
If you had surgery to improve blood flow to your legs, you need to continue to
care for your feet and toes.
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Avoid any situation that may cause foot injury
Do not expose your feet to extreme heat or cold (for example heating pads
or ice packs)
Avoid strong chemicals, disinfectants, and adhesives on your feet
Avoid going barefoot-even around the house and especially at night
Wear new shoes for short periods of time until broken in
Inspect your shoes before putting them on to check for any objects that may
injure your feet
Inspect your feet daily for areas of irritation. Check between toes for
cracking of the skin or sores
Do not soak the feet. Soaking removes natural oils and dries the skin
Wash with a mild soap and lukewarm water. Dry well
Apply oil or lotion daily if your skin is dry, but not between the toes
Cut toenails straight across – a podiatrist can perform your nail care for you
Rough nail edges should be filed smooth
If you have impaired vision, or cannot reach your feet, ask a family member
or friend to help you with this
If you have diabetes, a specialist should trim your nails and treat calluses
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Smoking
Smoking in any form must be avoided because it constricts blood vessels and
increases blood clotting.
Diet
It is important that your diet contain adequate amounts of calories, protein,
vitamins, and minerals to promote healing. The physician, nurse, or dietitian
will discuss any suggested changes in diet with you prior to hospital discharge.
Medications
You will be given prescriptions for your regular medications. If needed, a pain
medication will be prescribed. As healing occurs, discomfort along the incision
decreases and you will need less medication for pain.
Synthetic (Man-Made) Grafts
Often, synthetic (man-made) graft material is used for abdominal arterial
disease surgery. If synthetic graft material was used for your bypass, you will
need to take antibiotics prior to future surgery, dental work, or any invasive
procedure for the rest of your life. Antibiotics help to prevent possible infection
of the graft. Discuss this with the team providing care to you in the future and
be sure to tell them you have a synthetic bypass graft.
In Conclusion...
With recent advances in vascular surgery, abdominal arterial disease may be
treated with low risk of complications. Surgery or endovascular procedures
may improve or remove symptoms and restore you to a more independent
lifestyle. Remember that surgery or endovascular procedures do not cure
atherosclerosis. The disease process is still present. You can help to control
this. A firm commitment to keep regular follow-up appointments with the
physician, and to change your lifestyle to reduce risk factors, will help to
control further disease.
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For A
Better Understanding
ANGIOGRAM: An x-ray picture of any blood vessel (artery, lymphatic, vein)
obtained by an injection of dye into a blood vessel.
AORTA: The main artery of the body.
ARTERIOGRAM (angiogram): An x-ray picture of an artery obtained by an
injection of dye into a blood vessel.
ARTERY: A blood vessel carrying oxygen-rich blood from the heart to the rest
of the body.
ATHEROSCLEROSIS (Arteriosclerosis): Thickening and hardening of the
arterial wall caused by cholesterol and fat deposits inside an artery.
ATHERECTOMY: A procedure used to remove plaque with a catheter and
rotating blade.
BALLOON ANGIOPLASTY: Enlarging a narrowed artery by inflation of a
balloon catheter that cracks and flattens the plaque over a large area making
the space through which the blood flows widen. Dilation of a narrowed artery
by inflation of a balloon catheter.
BYPASS: An operation using synthetic (man-made) material or vein to reroute
blood flow.
CATHETER: A flexible tube placed in a blood vessel to inject dye, assist with
the removal of a blood clot, or inject medication.
CIRCULATION: The route through which the blood travels in the body.
CT SCAN: X-ray of body segments done by taking multiple horizontal pictures.
ENDARTERECTOMY: The removal of atherosclerotic plaque from the inner
wall of an artery by surgery.
ENDOVASCULAR: Treatment of arterial blockage or aneurysm by catheters
inserted into the arteries. This may involve the use of balloon catheters,
stents, or stent grafts.
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GRAFTS/BYPASS: Man-made material or vein that is used to re-route blood
flow.
INTRAVASCULAR ULTRASOUND (IVUS): A scan of the inside of the blood
vessel done through the projection of sound waves from a catheter passed
through an artery.
MRI/MRA: Imaging of body segments or vessels done by radio waves.
OCCLUSION: Blood vessel blockage.
PLAQUE: Cholesterol and fatty material build up on the inner lining of an
artery.
SIGN: Any concrete evidence of disease; indication of the presence of disease.
STAPLE: A metal clip that secures the edges of a surgical wound.
STENT: A small wire coiled mesh.
STENTING: Insertion of a small wire coiled mesh into the artery.
SUTURE: A stitch or series of stitches that secure the edges of a surgical
wound.
SYMPTOM: Any functional evidence of disease.
THROMBOLYTIC THERAPY: Use of medication by injection to dissolve blood
clots in a vein or artery.
VEIN: A blood vessel that carries the blood from the body back to the heart. A
blood vessel that may be used as a bypass to re-route arterial blood.
VENTILATOR: A machine that aids breathing.
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