Arterial Surgery at Wessex Hospital

What is arterial surgery?

Arterial surgery covers a range of operations to repair or bypass damaged or narrowed arteries, the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. Surgeons may clear out a blocked artery, create a new route around a blockage, or repair a weakened, bulging section.

What conditions does it treat?

• coronary artery disease, where plaque narrows the arteries supplying your heart, causing chest pain (angina) or a heart attack
• carotid artery disease, plaque buildup in the neck arteries supplying your brain, which raises your risk of stroke or transient ischaemic attack (TIA, sometimes called a mini-stroke)
• peripheral artery disease (PAD), narrowing of the arteries to your arms or legs, causing pain when walking (claudication) and, in severe cases, wounds that won't heal
• aortic aneurysms, a weakened, bulging section of your aorta, the largest artery in your body
• mesenteric artery ischaemia, reduced blood flow to your bowel
• renal artery stenosis, narrowing of the arteries to your kidneys, which can cause high blood pressure that's hard to control with medicine alone

What are the benefits of having arterial surgery?

Restoring blood flow can relieve symptoms such as chest pain, leg pain when walking, or slow-healing wounds, and it lowers your risk of serious complications like heart attack, stroke or loss of a limb. For coronary artery bypass grafting specifically, clinical trials show it relieves angina symptoms in 8 out of 10 people, with long-term outcomes often better than alternative treatments for people with several blocked heart arteries.

Are there different types or surgical approaches?

Arterial surgery falls broadly into open procedures and minimally invasive, or endovascular, procedures:

• bypass surgery uses a healthy blood vessel from elsewhere in your body, or sometimes a synthetic graft, to create a new route for blood around a blockage; coronary artery bypass grafting (CABG) is the version used for the heart, and peripheral artery bypass the version used for the legs
• endarterectomy is open surgery to remove plaque directly from inside an artery through an incision; carotid endarterectomy (neck) is the most common, alongside femoral (groin and leg), aortic and iliac (abdomen and pelvis), and rarer coronary or visceral versions
• angioplasty and stenting is minimally invasive, using a small balloon to widen a narrowed artery, often followed by a mesh stent to help keep it open
• atherectomy is another minimally invasive option, where a catheter with a blade at its tip shaves away plaque from inside the artery

For carotid artery disease, carotid stenting is generally reserved as an alternative for people at higher risk from open surgery. Which approach suits you depends on which artery is affected, how severe the disease is, and your general health.

What happens before the operation?

Your surgeon will discuss your symptoms, medical history, current medications and any allergies. You'll likely have imaging tests such as Doppler ultrasound, CT or MR angiography, or catheter-based angiography, and possibly heart tests like an ECG, echocardiogram or exercise stress test.

You may need to pause certain medications, such as blood thinners, or start taking an antiplatelet like aspirin beforehand, and you'll be told how long to fast before surgery. If you smoke, it's worth asking for support to help you stop before your operation.

Some health conditions make open surgery riskier, including decompensated heart failure, a recent heart attack, severe lung disease, previous radiation to the area, infection, or extensive calcification of the artery. If this applies to you, your surgeon may suggest a minimally invasive option such as stenting or atherectomy instead.

What happens during the procedure?

The exact steps depend on the type of surgery, but endarterectomy, one of the most common arterial operations, generally follows this pattern:

1. You're given anaesthetic, most often a general anaesthetic so you're asleep, though some neck surgery uses local anaesthetic so your surgeon can monitor your brain function throughout.
2. Your surgeon makes an incision directly over the blocked artery.
3. Blood flow is temporarily redirected around the area being treated, sometimes using a small tube called a shunt to keep blood reaching your brain during neck surgery.
4. The plaque is removed from inside the artery.
5. The artery is closed with stitches, sometimes reinforced with a patch made from a vein or synthetic material, and the incision is closed.

Bypass surgery works differently. Instead of clearing the blockage, your surgeon attaches a healthy blood vessel to create a detour around it, and heart bypass surgery additionally involves temporarily stopping and restarting your heart in many cases. Minimally invasive procedures such as angioplasty, stenting and atherectomy are done through a catheter rather than an open incision.

What is recovery like?

Hospital stays vary widely by procedure: around one day for a carotid endarterectomy, two to four days for a femoral endarterectomy, about a week for an aortic or visceral endarterectomy, and five to seven days for coronary artery bypass grafting (longer if it followed a heart attack). Some minimally invasive procedures need no overnight stay at all.

At home, expect some soreness, numbness, swelling or bruising around the incision for the first couple of weeks. Most people avoid driving and heavy lifting for one to two weeks after a more minor procedure, extending to around six weeks for major surgery such as bypass grafting, and you may be told not to lift more than 10 pounds for two months after an aortic or visceral endarterectomy while the area heals.

A follow-up appointment, often around four weeks after surgery, checks your incision and images the repaired artery, sometimes with ultrasound or CT scans. Cardiac rehabilitation, lifestyle changes and any prescribed medication all help reduce the chance of the problem returning.

What are the risks and complications?

• bleeding, infection, or an allergic reaction to anaesthesia or contrast dye
• heart problems, including irregular heart rhythms or a heart attack
• stroke, which carries a small but serious risk, particularly with carotid or heart surgery
• nerve damage near the incision site, which is often temporary
• blood clots or damage to the blood vessel itself
• re-narrowing of the treated artery over time, sometimes needing a repeat procedure