Vascular Surgery: Long-Term Care

There are many different types of vascular surgery. While recovery time can vary greatly for different types of vascular surgery, there are some general aspects of long-term care that apply to most types. It's important, however, to closely follow the guidelines given to you by your healthcare team. 

Benefits of Surgery

Because there are many different types of vascular surgery and many different methods of performing vascular surgery, there are many different benefits. Taking a look at a common vascular surgery—such as bypass graft surgery for peripheral artery disease (PAD)—we can learn an example of what the potential benefits could be.

Bypass surgery for peripheral artery disease (PAD) is done by removing a healthy blood vessel (or using an artificial or synthetic blood vessel) and using it as a replacement to bypass blood circulation that used to travel through the old, diseased vessel. 

The benefits of bypass surgery include:

• Relief of symptoms (including pain) from (PAD)
• Low incidence of major complications
• Can serve as a good treatment option when other, less invasive procedures (such as angioplasty and stenting) fail.
• Can prevent serious complications of PAD (such as the loss of a limb or help to improve wounds that will not heal)

Are There Any Disadvantages To Bypass Graft Surgery?

Because bypass surgery involves large surgical incisions, the wound healing is often a long process, in fact, according to the University of California, San Francisco, 20% of those who have bypass surgery have some sort of complication involving the surgical wound, these include:

• Swelling and minor infections (many of which can be treated with antibiotics and wound care at home)
• Complications that require prolonged hospitalizations and additional procedures

In general, approximately 60 to 70% of those who have bypass surgery can expect the surgery to last five years or longer. Approximately one-fourth to one-third of those who have had bypass surgery will require additional procedures to maintain the bypass grafts.

Possible Future Surgeries

Any type of vascular procedure can fail; the treatment must be managed correctly to ensure the best long-term outcome. Proper follow-up care after vascular surgery is considered the key to detecting recurrent disease and complications of surgery before recurring symptoms are noticed.

On a long-term basis, it’s vital to ensure that you follow your surgeon’s advice closely. It’s not uncommon for the necessity of future surgeries for people with vascular disease (even with proper follow-up care), but the earlier problems are detected, the better the outcome of future surgeries.  

Re-Hospitalization Due to Restenosis

Restenosis is a condition in which a blood vessel becomes narrowed again after treatment (such as angioplasty). A good example is after a carotid endarterectomy. This surgical procedure is performed to remove plaques in the carotid arteries (the blood vessels that carry oxygenated blood to the brain). There are two reasons that restenosis occurs after carotid procedures, these include:

• Early restenosis: This occurs less than 24 months after the procedure and is said to happen due to neointimal hyperplasia (thickening of the lumen [opening] of the blood vessel caused by vascular injury).
• Late restenosis: This occurs longer than 24 months after carotid procedures and is thought to be caused by the progression of atherosclerosis. Atherosclerosis is a condition involving plaque build up in the vessels; the plaque is comprised of cholesterol and other substances that occludes or causes a narrowing of the blood vessel). It is the most common reason for a carotid endarterectomy.

What is PTAS?

When restenosis or recurrent stenosis (narrowing) of the carotid arteries occurs, a treatment called percutaneous transluminal angioplasty (PTAS) is often performed. PTAS is considered a type of endovascular treatment that is considered a safe and effective alternative to carotid surgery. When surgical procedures are repeated to restore the patent opening of the artery, there can be serious complications. PTAS is thought to lower the chance of serious complications from re-surgery (such as neurological complications).

Lifestyle Adjustments

Lifestyle changes are an important aspect of long-term recovery after most types of vascular procedures. Even after having a relatively minor treatment for varicose veins, the vascular surgeon may recommend a specific walking program such as:

• Walking or cycling for 30 minutes, 5 days per week
• Avoiding certain activities such as yoga, weightlifting or distance running, which may stress the veins and cause the blood to back up.

Other, more serious types of vascular disorders (such as carotid artery disease) require more aggressive lifestyle changes. Although your surgeon can provide treatment to restore normal blood flow—by performing a carotid angioplasty and stenting or a carotid endarterectomy—these procedures do not cure the underlying, causative disease.

Lifestyle changes can help to slow down the progression of serious vascular disease, these lifestyle changes include:

• Quitting smoking: Smoking (and other forms of tobacco and nicotine use, such as vaping and chewing) causes damage to the walls of the arteries. This damage occurs in every area throughout the body and is directly linked with atherosclerosis (which used to be referred to as hardening of the arteries). Quitting smoking has been found to slow the progression of arterial disease (such as carotid artery disease or CAD).

• Control high blood pressure: High blood pressure causes the blood to move through the vessels with more force and stress against the arterial walls. Long-term lifestyle changes after vascular surgery include having your blood pressure checked regularly and may include taking antihypertensive (high blood pressure) medications as ordered by your healthcare provider.
• Control your cholesterol levels: Have your cholesterol checked on a regular basis, eat a healthy diet, low in saturated fats, and take medication to lower cholesterol (such as statins) as ordered by your healthcare provider.
• Eat a healthy diet: A healthy diet can lend itself to controlling risk factors for the progression of vascular diseases such as high blood pressure and obesity.
• Note, talk to a member of your healthcare team about the exact diet you should follow, after vascular surgery. If you are having trouble implementing a healthy diet, ask your healthcare provider for a referral to consult with a dietician.
• Exercise regularly: Employing a regular exercise routine—such as engaging in 30 minutes of moderately strenuous exercise each day—is an important lifestyle change to reduce the risks linked with the progression of vascular disease (such as obesity and high blood pressure). However, it’s important that before you begin any type of exercise routine, you get the approval of your healthcare provider.
• Drink alcohol in moderation: Drinking too much alcohol lends itself to high blood pressure, obesity, and other risk factors for vascular disease. The American Heart Association recommends that men limit their consumption of alcohol to no more than one to two drinks per day, and one drink per day for women. A drink should consist of no more than 12 ounces of beer, 4 ounces of wine, or 1.5 ounces of spirits (80 proof).
• Manage stress: Stress plays a big part in many factors that lend themselves to the progression of vascular conditions; the stress response contributes to high blood pressure and to atherosclerosis. To effectively manage stress, you may want to explore taking a special course designed specifically for people with heart disease and other conditions that are impacted by stress. The course is called Mindfulness Based Stress Reduction (MBSR), and it’s been studied for its effectiveness in improving anxiety and depression and helping patients with medical conditions (such as heart disease) with perceived stress while improving physiological symptoms such as lowering blood pressure in those with heart conditions.

A Word From Verywell

No matter what type of vascular surgery you receive, it's important to follow the long-term recovery instructions from your healthcare provider. If you worry you may stray from your healthcare provider's orders, have someone close to you offer an accountability check every so often. What you do during your recovery can determine whether you need to have more procedures done in the future.