These notes give an overall guide to your stay in hospital. You may see some differences in the details of your treatment, since it is tailored to suit your own condition.

• What is the problem?
• What does the operation consist of?
• What happens before the operation?
• What happens after the operation?
• General Advice

WHAT IS THE PROBLEM?

The main artery which carries blood down your leg is blocked just above the knee. The calf, foot and toes are starved of blood. This causes pain and can lead to serious infection and loss of the toes. We can bypass the blocked part of the artery so that blood flows properly again.

WHAT DOES THE OPERATION CONSIST OF?

A number of cuts are made in the skin down the inside of the thigh so that the artery above and below the block can be seen. A bypass is constructed using one of your own veins or a special artificial material. This is stitched into the artery above and below the block so that the blood flows down the bypass towards the toes.

WHAT HAPPENS BEFORE THE OPERATION?

Reception

When registering at reception your medical aid details will be required. Your medical aid may require that you obtain an authority number from them for the hospital. Please check this. If you are not on a member of a medical aid you will be required to pay a deposit or to sign an indemnity form. As far as possible we will try to advise you about hospital costs before your admission.

Welcome to the ward

You will be welcomed to the ward by the nurses or the receptionist and will have your details checked. Some basic tests will be done such as pulse, temperature, blood pressure and urine examination. You will be asked to hand in any medicines or drugs you may be taking, so that your drug treatment in hospital will be correct. Please tell the nurses of any allergies to drugs or dressings. The surgeon will have explained the operation and you will be asked to sign your consent for the operation. If you are not clear about any part of the operation, then read this again and then ask for more details from the surgeon or from the nurses.

Visit by the anaesthetist

The anaesthetist who will be giving your anaesthetic will interview and examine you. He will be especially interested in chest troubles, dental treatment and any previous anaesthetics you have had. He may want to use a spinal or epidural anaesthetic. This helps with pain control after the operation. He will talk to you about this

Diet

You will have your usual diet until 6 hours before the operation when you will be asked to take nothing by mouth. This will let your stomach empty to prevent vomiting during the operation.

Shaving

The operation area will be shaved to remove excess hair.

Timing of the operation

The timing of your operation is pre-arranged so that the nurses will tell you when to expect to go to the operating theatre. Do not be surprised, however, if there are changes to the exact timing.

Transfer to theatre

You will be taken on a trolley to the operating suite by the staff. You will be wearing a cotton gown, wedding rings will be fastened with tape and removable dentures will be left on the ward. There will be several checks on your details on the way to the operating theatre where your anaesthetic will begin.

The operation is then performed.

WHAT HAPPENS AFTER THE OPERATION?

Coming round after the anaesthetic

Although you will be conscious a minute or two after the operation ends, you are unlikely to remember anything until you are back in your bed on the ward. Some patients feel a bit sick for up to 24 hours after operation, but this passes off. You will be given some treatment for sickness if necessary. You may be observed in the High Care Unit after the operation, particularly if you have a past history of heart or chest problems. A catheter will have been placed into your bladder during the operation. This can sometime irritate and give you a sensation of wanting to pass water.

Will it hurt?

The wound is painful and there is discomfort on moving rather than severe pain. You will be given injections or tablets to control this as required. Ask for more if the pain is still unpleasant. You will be expected to get out of bed the day after operation despite the discomfort. You will not do the wound any harm, and the exercise is very helpful for you. The third or fourth day after operation you should be able to spend most of your time out of bed and in reasonable comfort. You should be able to walk slowly along the corridor. By the end of the week the wound should be virtually pain free.

Drinking and eating

You should be able to drink the same day as your operation and move to a normal diet within a day or two.

Opening bowels

It is quite normal for the bowels not to open for a day or so after operation. If you have still not opened your bowels after 2 days and feel uncomfortable ask for a laxative.

Passing urine

If there is a drainage tube (catheter) in the bladder, passing urine is not a problem. Sometimes there is a feeling that there is a leakage all the time, but this is just an irritation by the tubing and it passes off. Once you can walk about in reasonable comfort, the catheter is taken out. If you have not had a catheter it is important that you pass urine and empty your bladder within 6-12 hours of the operation. If you find using a bed pan or a bottle difficult, the nurses will assist you to commode or the toilet. If you still cannot pass urine let the nurses know and steps will be taken to correct the problem. If you have had a catheter in the bladder, you must pass urine after the catheter is taken out. If you can't, ask the nurses for advice.

Sleeping

You will be offered painkillers rather than sleeping pills to help you to sleep. If you cannot sleep despite the painkillers please let the nurses know.

Physiotherapy

The physiotherapist will check that you are clearing your lungs of phlegm by coughing and that you are helping your circulation by movement of your arms and legs. Coughing although uncomfortable, will not harm your wound. The physiotherapist will also help you with mobilisation exercises for your leg.

The Wound

All the wounds have dressings which may show some staining with blood in the first 24 hours. The wounds are held together by stitches which are removed after 8-10 days. The dressing is usually removed after 1-3 days and replaced. This dressing is usually waterproof allowing you to shower. Sometimes plastic drains are used to drain excessive secretions from the wounds. They may be slightly uncomfortable but are removed after a few days. There may be some purple bruising around the wounds which spreads downward by gravity and fades to a yellow colour after 2 to 3 days. It is not important. There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wounds will fall off. Occasionally minor matchhead sized blebs form on the wound lines, but these settle down after discharging a blob of yellow fluid for a day or so.

Washing

You can wash the wound area as soon as the dressing has been removed or earlier with a waterproof dressing. Soap and tap water are entirely adequate. Salted water is not necessary.

How long in hospital?

Usually you will feel fit enough to leave hospital after 7 to 10 days provided the legs are healthy. You will be given an appointment for a check up about a 1 to 2 weeks after your operation.

Sick notes

Please ask your surgeon for any sick notes or certificates that you may require.

After you leave hospital

You are likely to feel a bit tired and need rests 2 or 3 times a day for two weeks or more. The wound is likely to be quite uncomfortable for a month. if there were ulcers or loss of skin before the operation then these areas may take a month or two to heal. After two to three months you should be back to your usual level of activity.

Lifting

At first discomfort in the wound will prevent you from harming yourself by too heavy lifting. After two months you can lift whatever you like. There is no value in attempting to speed the recovery of the wound by special exercises before the month is out.

Driving

You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about 3 weeks.

What about sex?

You can restart sexual activities within 3 to 4 weeks, when the wound is comfortable enough.

Work

You should be able to return to light work within 4 to 6 weeks and a heavy job within 3 to 4 weeks.

Complications

Early clotting of the graft is the main problem. It causes your symptoms to come back. A repeat operation may be needed. The Surgeon will talk to you about this. Infection in the wound sometimes happens and rarely an artificial graft may become infected which is a difficult problem and the graft would probably have to be removed. After a wound infection the wound sometimes gapes and is slow to heal. This gradually settles down. Late clotting of the graft can occur. You will be given treatment to prevent it and advice to avoid long car and plane journeys without hourly exercise. Aches and twinges may be felt in the wound for up to 6 months. Occasionally there are numb patches in the skin around the wound which may get better after 2 to 3 months. The risk of limb loss after a bypass is about 1%.

GENERAL ADVICE

The operation gives good results, but the underlying hardening of the arteries may cause problems later. You must not smoke, because graft failure is almost certain if you do. If you have any problems or queries, please ask the nurses or doctors.

You must NEVER SMOKE after the operation.

Sometimes you may be given tablets to thin your blood making clotting less likely. In this case you will need regular blood tests to monitor the amount of the drug you will need. If you have any problems or queries, please ask the nurses or doctors.