Vascular Surgery: How to Prepare

When it comes to vascular surgery, your diagnosis and treatment plan will dictate what you need to do to prepare for your upcoming operation. In general terms, there are two types of surgery, including:

• Endovascular procedures: Surgery that is performed inside your blood vessels utilizing very thin, long tubes called catheters. This is normally done on an outpatient basis.
• Open procedures: A traditional type of surgery in which an incision is made using a scalpel. This is most often performed after a person is admitted as an inpatient to the hospital and is usually done under general anesthesia.

Whether you are having a procedure to have your varicose veins repaired, or a major type of vascular surgery, your surgeon will give you a list of specific guidelines on how to prepare for your vascular surgery. There are some general guidelines that pertain to getting ready for most types of vascular surgery, but first and foremost, always follow your surgeon’s instructions.

Location

Today, many types of vascular procedures are being performed in an outpatient setting. This may include a wide range of facilities, such as vascular access centers (also known as vascular centers), which is an outpatient facility that provides critical care and maintenance to those undergoing dialysis. Vascular access centers provide state-of-the-art minimally invasive treatments for people with all types of vascular diseases. Other settings include:

• Same-day surgery
• Outpatient surgery centers
• Physician’s offices
• Dialysis centers (for some minimally invasive procedures such as dialysis access procedures)

Inpatient and outpatient surgery can both be done in a hospital setting. The primary difference between the two types of surgery is where a person sleeps the night after the procedure. Outpatient surgery—also referred to as same-day surgery or ambulatory surgery—involves a procedure that is done on the same day that the person goes home.

So, while every vascular procedure will certainly not involve the exact same setting, there are some generalities when it comes to which vascular procedures are done on an inpatient basis and which are performed in an outpatient setting, as well as the average number of hospitalization days—if any— these include:

Technically, an overnight stay can be considered inpatient or outpatient, depending on whether you have been admitted to the hospital. Sometimes the physician orders an overnight stay for observation to decide whether a person should be admitted).

Depending on many different factors, your vascular surgeon will order the type of procedure and the setting it is to be performed in (inpatient, outpatient, office, etc.), these factors include:

• Your medical condition
• The type of procedure you are having
• The type of anesthesia you will get
• Any risk factors for complications that you may have such as older age, heart, or kidney disease

Your length of hospital stay will depend on factors such as:

• What type of anesthesia you receive
• The type of procedure you are having
• Your medical history

After your procedure, you may be taken to different areas of the hospital, depending again upon the type of procedure, how sedated you were during the procedure, and other factors. You may be sent to:

• Post-anesthesia care unit (PACU)
• Outpatient postoperative care area (Step-down or Phase II recovery)
• Intensive care unit (ICU)

Exactly when you’ll be transferred to a regular hospital room or discharged home will hinge on several factors such as:

• Are you taking fluids by mouth without getting sick?
• Are you urinating?
• Are your vital signs (blood pressure, pulse, and respirations) normal
• Are you walking without assistance?

What to Wear

When you get ready to go to the hospital or the outpatient surgery center, be sure to wear:

• Loose-fitting, comfortable clothing. You may have a marker on your leg denoting where a blood vessel is located; you won’t want to accidentally rub it off.
• Flat, slip-proof athletic style shoes or comfortable shoes that are easy to put on and take off.

Although you will be given a hospital gown upon admission, you may want to pack some regular clothing for after your procedure. It’s important to bring loose-fitting, soft cotton materials to avoid rubbing on your incision site and prevent excess skin irritation. You may experience muscle aches and other pain from being immobile and from the surgery itself. Wearing loose, comfortable clothing will aid your overall recovery after your surgical procedure by helping to reduce your level of discomfort.

Food and Drink

A member of your surgical team—such as a nurse—will advise you on exactly when to stop eating and drinking fluids before your surgery, be sure to closely follow these instructions.

For most surgical procedures—including most endovascular procedures—you will be instructed not to eat or drink anything after midnight the night before surgery. This is because having food and liquid in the stomach increases the risk of getting nauseated and vomiting in response to the anesthesia.

If you are ordered to take any of your medications the day of surgery, it’s okay to take small sips of water to get the pills swallowed. Be sure to avoid sucking on hard candy or chewing gum as well as abstaining from eating solid food or drinking any type of liquids. If you don’t follow your surgeon’s protocol, this could result in the need to have your procedure rescheduled.

Medications

A member of your surgical team will review your medications with you to decipher which ones you should stop taking before surgery and which will be ordered to continue taking. It’s important to provide a list of each type of prescription medication, over the counter drug, herbal and natural preparations—including vitamins—as well as topical (on the skin) creams and ointments that you take. On your list of medications, include the dosage and the time/s of day that you take them.

Anticoagulants (Blood Thinners)

Be sure to include any type of medication that is considered a blood thinner, such as:

• Warfarin (Coumadin)
• Rivaroxaban (Xarelto)
• Dabigatran (Pradaxa)
• Apixaban (Eliquis)
• Edoxaban (Lixiana)

Your anticoagulant will be discontinued and it’s possible that your healthcare provider will order a different type of blood thinner instead. Unless you are ordered to stop, you may be ordered to continue taking aspirin or clopidogrel (Plavix).

According to the Frankel Cardiovascular Center, there are several types of medications that should be discontinued before your vascular surgery, including:

Two weeks before your surgery, discontinue:

• Coenzyme Q10 (CoQ10)

Seven days before your surgery, stop taking NSAIDs (non-steroidal anti-inflammatory drugs) and those that contain NSAIDs, salicylates, and other medications that decrease clotting time, such as:

• Motrin (ibuprofen)
• Aleve (naproxen)
• Haltran (ibuprofen)
• Lodine (etodolac)
• Medipren (ibuprofen)
• Midol (ibuprofen)
• Motrin (ibuprofen)
• Nalfon (fenoprofen)
• Naprelan (naproxen)
• Naprosyn (naproxen)
• Nuprin (ibuprofen)
• Orudis(ketoprofen)
• Relafen(nabumetone
• Tolectin (tolmetin)
• Trilisate (salicylate)
• Voltaren (diclofenac)

Seven days before your surgery stop taking weight-loss, nutritional and herbal supplements, including:

• Alpha-Lipoic Acid
• Acetyl-L-carnitine
• Cinnamon
• Chamomile
• Creatine echinacea
• Ephedra
• Fish Oil
• Garlic
• Ginger
• Gingko Biloba
• Ginseng
• Glucosamine chondroitin
• Glutamine
• Goldenseal
• L-carnosine
• Licorice
• Kava kava
• Milk thistle
• Multivitamin
• Omega-3
• Resveratrol
• Skullcap
• St. Johns’ wort
• Vitamin E

The night before surgery, your surgeon will advise you regarding any changes in your insulin dosage/s that may need to be made the night before and/or the day of your vascular procedure.

The list of medications that are important to stop taking before your surgery is not all-inclusive. Be sure to provide your surgeon with a complete list of medications that you take and follow the healthcare provider’s instruction closely on what to stop taking and when.

Do not smoke for at least two weeks before your procedure.

What to Bring

When planning what to bring to the hospital or surgery outpatient center, be sure to bring:

• A copy of your legal paperwork: This is anything pertaining to your health such as advanced directives including your healthcare proxy or living will.
• Any special equipment: Things like a CPAP machine.
• Compression stockings: These will help prevent blood clots, particularly when a person is inactive or bedridden—such as after surgery. You should consult with your surgeon as to whether you should wear your compression stockings to the hospital or outpatient center or bring them with you.
• Containers for belongings: This is helpful for your eyeglasses, dentures, or any other prostheses.
• A picture ID: Such as a driver’s license or state ID.
• Insurance and emergency contact information: It's important to have this easily accessible.
• Your cane or walker: This should be labeled with your name on it.

You should pack a bag of clothes and have someone bring it to the hospital after you are moved from the surgical suite into a regular hospital bed, this bag should include:

• A robe and slippers with a rubber backing (or other comfortable, easy to don, slip-proof shoes)
• Reading materials
• Loose-fitting clothes to go home in

You should leave some personal items at home, including:

• Wedding rings, watches, or other jewelry
• Credit cards
• Cash (other than a small amount if you want to shop at the hospital gift shop)

Pre-Op Lifestyle Changes

Once your vascular surgeon or other healthcare provider has scheduled you for vascular surgery, you’ll need to get prepared; part of the preparation is finding out what to expect and learning what will help ensure the best surgical outcome. Another part of preparation is employing some lifestyle changes, such as quitting smoking before your surgery. The more prepared you are upfront, the better your overall experience will be, which may lend itself to speedier recovery with fewer complications.

Eating a healthy diet and exercising regularly—with the approval of the healthcare provider—are encouraged whenever a person has a surgical procedure of any type. But, perhaps one of the most important lifestyle changes when getting ready for vascular surgery, is to stop smoking before your surgery. The sooner you quit, the better.

According to the World Health Organization, smoking delays healing and increases the risk of postoperative complications. Those who smoke were found to have a longer hospital stay and an increased chance of needing to be transferred to the intensive care unit after surgery. It was also found to cause poor wound healing and even increase the risk of death.

The sooner you quit the better, but you must stop smoking and vaping at least two weeks before your surgery according to the experts.

If you need help quitting, here are a few resources to help you:

• The Truth Initiative
• US Department of Health and Human Services
• National Cancer Institute (Smokefree.gov)
• NCI’s telephone quitline: 877-44U-QUIT (877-448-7848); (English and Spanish)
• Local and state: 800-QUIT-NOW (800-784-8669

A Word From Verywell

If you have a vascular disorder, you may be contemplating whether to see a specialist. One thing to keep in mind when it comes to vascular surgeons is that they are the only providers who are highly specialized in providing every type of treatment modality for vascular disorders. Don't wait to discuss your options with your healthcare provider.