The procedures
Vascular surgery treats diseased arteries and veins. Common operations include:
- Carotid surgery: removing narrowing from the main artery in the neck to reduce the risk of stroke.
- Aortic aneurysm repair: treating a weakened, enlarged section of the aorta, the body's largest artery. This may be an open repair through an incision in the abdomen or chest, or an endovascular repair (EVAR), where a stent-graft is placed from inside the artery through small groin incisions.
- Leg artery surgery: bypass operations or stenting to improve blood flow to the legs.
- Amputation: when blood flow cannot be restored or infection cannot be controlled, removing part of a limb can relieve pain and allow healing.
The role of your specialist anaesthetist
Many of my vascular patients have narrowed arteries elsewhere in the body as well, including the heart and brain, and many also have diabetes, lung disease or reduced kidney function. My role is to understand your individual risk, plan an anaesthetic that protects your heart, brain and kidneys, manage blood pressure and blood loss during surgery, and arrange the right level of care afterwards.
Common anaesthetic approaches
- Carotid surgery may be done under general anaesthesia, or under local or regional anaesthesia so that you stay awake and your brain function can be checked directly. Both approaches are well established.
- Open aortic repair is done under general anaesthesia, often with an epidural or other technique for pain relief afterwards.
- Endovascular repair may be done under general anaesthesia, regional anaesthesia, or local anaesthetic with sedation.
- Leg surgery and amputation may use general anaesthesia, a spinal anaesthetic, nerve blocks, or a combination. Nerve blocks or a catheter near the nerve can give good pain relief after amputation.
Which approach suits you depends on the operation, your health and your preferences. Not every technique is suitable for every patient, and we will decide together.
Preoperative assessment and preparation
Assessment before vascular surgery is often more detailed than for other operations. I will review your heart and lung health, kidney function, diabetes control, previous strokes or heart problems, and how active you are day to day. Some patients need extra tests, such as heart scans or lung function tests, or a review by a cardiologist or physician. For major surgery, I may use a formal risk calculator, such as the American College of Surgeons NSQIP calculator, to estimate your individual risk and guide our discussion.
Many vascular patients take blood thinners, antiplatelet medicines, blood pressure tablets or diabetes medicines. Some should continue and others may need a change, and this is decided individually with your surgeon and other doctors. Please do not stop any medication unless you have been advised to. See Medications Before Anaesthesia.
If you smoke, stopping before surgery, even for a short time, helps. Support is available through Quitline on the Quit website.
What happens during the procedure
For most vascular operations I place an arterial line, a fine tube in the wrist artery that measures blood pressure with every heartbeat. For major operations a central line in a large neck vein is also common, along with a urinary catheter to monitor kidney function. Blood pressure is managed closely, especially when the surgeon temporarily clamps an artery.
Kidney protection includes keeping blood pressure and fluid balance well controlled, and limiting the use of medications and X-ray contrast that may strain the kidneys. For some aortic repairs that extend into the chest, a spinal drain is placed in the lower back before surgery. It lowers the pressure around the spinal cord and helps protect its blood supply.
Recovery and postoperative considerations
After open aortic surgery and some other major operations, you will usually be cared for in the intensive care unit (ICU) or a high-dependency unit for one or more days. After carotid surgery and endovascular repair, recovery is often quicker, with close monitoring for the first few hours. Good pain relief allows you to breathe deeply, cough and get moving, which reduces the risk of chest infection and blood clots. See Recovery & Aftercare.
Relevant anaesthetic risks and precautions
Because many vascular patients have heart disease, the risk of heart problems around the time of surgery, such as a heart attack or irregular heart rhythm, is higher than for many other operations. Other risks include changes in kidney function, stroke, chest infection, blood clots and the need for a blood transfusion. Confusion after surgery is more common in older people. A spinal drain has its own small risks, including headache and, rarely, bleeding, and these are discussed before it is placed.
These risks vary greatly from person to person. I will talk with you about the ones that matter for you, and how they are reduced. See Anaesthetic Safety & Risks.
Links to additional patient resources
- Preparing for Your Procedure
- Understanding Your Anaesthetic & Informed Consent
- Medications Before Anaesthesia
- Recovery & Aftercare
- Preparing for your operation, Australian and New Zealand College of Anaesthetists (ANZCA)