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Surgical Care
Our surgeons specialize in general, vascular, laparoscopic, endovascular, endocrine, colorectal and breast surgery. Patient Forms Download patient history and personal data sheet here. Click on link, open file and answer questions. Once finished with questions please save file and e-mail to operez@socsmg.occoxmail.com or print and bring in to office. Click here to Download the Hippa Privacy Form Frequently Asked Questions The information provided is for general knowledge and should not be substituted for any information provided by the surgeon directly. Please call the office with any questions regarding specific care or questions.  Anorectal Diseases FAQ'sPerirectal/perianal abscess FAQ's
How much pain should I experience? How much bleeding or discharge should I experience? What if I have difficulty urinating? How much pain should I experience? Post-operative pain is expected but should be equal to or less then what was experienced before the surgery. How much bleeding or discharge should I experience? Bleeding or discharge is expected until the abscess area heals. However, it may persist if a track is forming from the anal canal to the outside drainage site. This persistent drainage will be addressed by your surgeon in the office during your follow-up visits. What if I have difficulty urinating? You should void within 6-8 hours after your surgery. If you cannot, you need to notify your surgeon or be seen at the nearest emergency room Back to Top Fissurectomy Sphincterotomy FAQ's
How much pain should I expect? How much bleeding should I expect from the surgical incision? How long will it take to heal? What if I get constipated? How much pain should I expect? You may experience pain but not more than the pain you have been experiencing previously from the fissure. The pain should around a week. How much bleeding should I expect from the surgical incision? The bleeding seen should be minimal and is essentially just discharge onto the surgical dressing. How long will it take to heal? The healing process may take up to three weeks. What if I get constipated? It is important to avoid constipation. Take stool softeners immediately after surgery and if you don't experience a bowel movement within two days, you should take one dose of milk of magnesia. Back to Top Hemorrhoidectomy FAQ's
How much pain should I expect after the surgery and for how long should it last? How much bleeding should I expect? What happens if I cannot urinate? How much swelling should I expect to have? How should I treat the wound? What if I get constipated? How much pain should I expect after the surgery and for how long should it last? Post-operative pain is expected to last for about one week to ten days. The first three days are the worst and it should gradually get better. After the surgery, your doctor should prescribe you pain medication to take home. How much bleeding should I expect? Minimal bleeding is expected and normal, but should you experience significant bleeding with clots you should notify your surgeon. Some bleeding may last for about two to three weeks. What happens if I cannot urinate? Some patients (more commonly in men) occasionally experience difficulty urinating after surgery. If you cannot void for 6 to 8 hours after the procedure, please notify your surgeon or go to emergency room. How much swelling should I expect to have? Some swelling is expected and normal post procedure and will likely last three to four weeks. How should I treat the wound? Dry gauze as needed. Occasionally Sitz baths, soaking area will be used. If in doubt ask your surgeon. What if I get constipated? You should have a bowel movement within two days after the procedure. If not, take one dose of milk of magnesia. Continue taking recommended stool softeners (usually Colace) as long as you are using the pain medications. Back to Top Fistula in ano FAQ's
How much pain should I expect? How much discharge should I experience? How much bleeding should I experience? What if I get constipated? How much pain should I expect? If the fistula is open, you should experience some pain for about 5 days after your surgery and it will then start to subside. If a loop is placed into the track then the pain is usually less. How much discharge should I experience? Discharge is expected and is normal. It may last for a week until the wound is healed. How much bleeding should I experience? Minimal bleeding is expected and usually presents itself as pinkish discharge. However, if you notice a lot of blood at the incision site, please notify your surgeon. What if I get constipated? You should have a bowel movement within two days of the surgery. Otherwise, take one dose of milk of magnesia. Back to Top Breast Surgery FAQ's
Will I have any sort of a drain? How long does the drain stay in place? What does the drainage supposed to look like? How often do I need to empty the drain? Can I shower with the drain in place? What if I cannot get the drain to hold its suction? How long will I stay in the hospital? How soon can I drive? When can I exercise? What should I call the office for? If I have a catheter for radiation seeds is it normal for there to be drainage? How long should I need pain medication? How soon can I return to work? What is arm lymphedema? Breast Surgery Links Will I have any sort of a drain? You will most likely have a drain if you have a mastectomy or an axillary lymph node dissection. How long does the drain stay in place? The drain is removed whenever the drainage is below/around 30cc a day. Usually that takes about 7-10 days but can on occasion take up to 3 weeks What does the drainage supposed to look like? The first several days the drainage will be red and then turn more yellow. Sometimes there will be fibrin clot like material within the drain and that is the reason for "milking" the drain several times a day How often do I need to empty the drain? Usually twice a day is fine and record the amount emptied. If needed empty more often. Can I shower with the drain in place? Keep the drain exit site as clean and dry as possible. Apply a new dressing daily or as needed. What if I cannot get the drain to hold its suction? Call us around 9 am the next morning; this may require you to come in for an evaluation in the office (or emergency room if on the weekend). How long will I stay in the hospital? With a lumpectomy you will be an outpatient and return home the same day. With a mastectomy without reconstruction you will be discharged the same day or spend a single night in the hospital With a mastectomy with reconstruction you will stay at least one night and maybe more depending on the type of reconstruction. How soon can I drive? You can begin driving after 72 hours provided that you are moving comfortably and not on pain medications. Please confirm that the plastic surgeon (if reconstruction performed) is also ok with you driving. When can I exercise? You can begin light exercise like walking upon your return home. Light arm exercises should begin the day after the drain is removed or 7 days after surgery if you do not have a drain. What should I call the office for? You should call for any temperature above 101, drainage from the incision that is new, severe redness and tenderness at the incision site or significant swelling. If I have a catheter for radiation seeds is it normal for there to be drainage? Absolutely, the reason for that is there cannot be any fluid around the balloon in order the deliver the radiation and that fluid must be allowed to drain out around the catheter. It is a nuisance but very normal. How long should I need pain medication? That is variable depending on the surgery, number of nodes removed etc. Usually by one week you can manage your pain with over the counter Tylenol, Aleve etc. The patients having bilateral mastectomy and reconstruction sometimes require stronger pain medication for longer periods of time How soon can I return to work? This is dependent upon the physical requirements of your employment. We suggest discussing that with your surgeon as well as your plastic surgeon, when involved. What is arm lymphedema? This is swelling in the arm after removal of axillary lymph nodes because of interruption of the normal drainage pattern. This is why a drain is placed after an axillary lymph node dissection. Lymphedema occurs rarely after sentinel node removal and is increased with formal axillary node removal and also radiation to the axilla. It is normal for some swelling of the arm initially but this will likely resolve within 4-6 weeks. Lymphedema can come on years after surgery. Whenever you feel or notice that you are developing tightness or swelling of the arm or hand, make an appointment to see the surgeons so that we can evaluate and start lymphedema treatment when appropriate. There are many myths revolving around lymphedema and it is best to ask your doctor his or her feelings regarding things like Blood Pressures, blood draws etc. The majority of time this can be very effectively treated, and the earlier it is found the better the treatment results. Occasionally lymphedema may be permanent. Links Additional Breast Surgery Information Breast Lumpectomy Breast Mastectomy Medline Plus (research questions about diseases and surgery) Back to Top Colon surgery FAQ's
Will my stools be normal after the surgery? When do the staples come out? When can I do normal activities? What if I have diarrhea (loose stools)? When do I follow up in the office? What will the postoperative diet be when I go home? How much pain the surgery cause? How is the colon reconnected? When do I eat after surgery? Colon Surgery Links Will my stools be normal after the surgery? This depends on the amount of colon removed. Generally if only a portion is removed stool may be loose for a while and return close to preoperative normal over a few days/weeks. When do the staples come out? Staples will stay for 7-21 days depending on patient characteristics and any underlying comorbidities. When can I do normal activities? This may vary depending on a number of factors, but generally activities may resume as follows. Walking - before leaving hospital Driving - one week (ideally off of narcotic medications and moving comfortably) Working - if no strenuous activity is required then around 2 weeks after surgery Lifting/straining - 8 weeks after surgery What if I have diarrhea (loose stools)? If you are having more than 5-7 bowel movements per day then you should call the surgeon or go to the emergency room. Occasionally an infection may cause this. Avoid anti-diarrhea medication (Imodium) unless approved by your surgeon. Drink plenty of fluids to avoid dehydration. When do I follow up in the office? Follow up in the office after discharge depends on the length of time in the hospital. Typically hospitalization would be 4-5 days and thus follow up would be around 1 week after hospitalization. What will the postoperative diet be when I go home? This may vary, but typically either a low residue or a mechanical soft diet will be ordered. How much pain the surgery cause? Most patients have moderate to severe pain for the first day and by discharge have mild pain that can be controlled with oral pain medications. How is the colon reconnected? Typically the colon would be stapled back together with specialized staples. When do I eat after surgery? This may vary depending on portion of colon removed. Generally liquids are started anywhere from day one to day three after the surgery and advanced to a solid diet before discharge. Colon Surgery Links colectomy (colon surgery) Medline Plus (research questions about diseases and surgery) Back to Top Gallstones/gallbladder disease FAQ's
How long is the operation? What are the risks of laparoscopic cholecystectomy surgery? Where do I show up and when? Do I need my Gallbladder? When can I shower? When can I work or drive? Are there any activity restrictions? Is bruising normal? Do I need to have stitches removed? When should I make a follow up appointment? How will I know if I have an infection? What should I do if I am constipated? Gallstone/Gallbladder Disease Links How long is the operation? Most laparoscopic cholecystectomy operations take 1-2 hours. What are the risks of laparoscopic cholecystectomy surgery? Laparoscopic cholecystectomy is considered safe and relatively low risk, but risks include and are not limited to intra- or post operative bleeding, infection, arterial, or venous injury, liver or bowel injury, biliary injury or post operative leak conversion to open surgery (approx 5%). The most serious injury is a biliary duct injury, injury to the bile ducts (1% or less). This requires conversion to open surgery and may even lead to additional surgery to repair the injury. Where do I show up and when? The office will give that information. There are 2 hospitals and 2 surgery centers that this surgery is performed at. Do I need my Gallbladder? No, the gallbladder is simply a storage bag for bile. The liver is capable of adapting and making more then enough bile to help digest your food after your gallbladder is removed Occasionally people can have bowel changes (i.e. loose stools) after this surgery. When can I shower? If your surgeon used skin glue you can shower the next day. Do not scrub glue or take baths. The glue will fall off in 2-3 weeks. You can remove it in three weeks if it still there. If there are steri-strips or staples you may shower in ~3 days. When can I work or drive? Most people can drive and work in 1 week. The criteria for driving include not taking narcotic pain medication and moving around comfortably enough to drive stafely. Some people return to work and drive in 3-4 days and some not for 10-14 days. Are there any activity restrictions? For laparoscopic cholecystectomy operations, patients can and should walk the next day and stairs are okay. No heavy lifting more than 20lbs for 4 weeks. Light jogging and the exercise bike are fine after 2 weeks. Sexual activity is probably safe in 2 weeks. If there is any pain or discomfort wait a total of 4 weeks. In general full activity can be resumed in 4 weeks. Is bruising normal? Yes, some bruising and swelling is expected and is normal. Expanding bruising suggestive of active bleeding is not normal, so call the surgeon for any questions. Do I need to have stitches removed? No, almost all stitches are under the skin and will absorb in time. They do not need to be removed. On occasion sutures/staples are in skin and will stay 1-2 weeks. When should I make a follow up appointment? Call to make a follow up appointment with our medical staff in 7-10 days after surgery. Most laparoscopic cholecystectomy patients follow up with our medical assistants unless there is a problem. Surgeons are always available for appointments if necessary. Are staff is very prepared and well trained to handle post op issues. How will I know if I have an infection? Infections are rare, 1% or less. They generally present with expanding wound redness a few days after surgery and can present even weeks later. Post op redness is normal and usually resolves in a few days. If it does not resolve or redness resolves then recurs call for an appt. Some drainage is normal but our offices should evaluate increasing drainage or persistent drainage. What should I do if I am constipated? Constipation is may occur. Several options for treatment include milk of magnesia, fleet enemas, Miralax, prune juice, mineral oil. Drink plenty of water and eat a high fiber diet, Metamucil, Citrucel, benefiber can also be helpful to treat and prevent constipation. If these treatments are not working please call the office. Links Additional Abdominal Surgery Information cholecystectomy (removal of gallbladder) Medline Plus (research questions about diseases and surgery) Back to Top Hernia FAQ'sWhat is a hernia? A hernia is a hole/weakness of the fascia. Like the entire lining of the abdomen it is lined with a layer called peritoneum. This makes up what is called the hernia sac. Are all hernias the same? No. There are many types of hernias. Some are more problematic than others. What causes hernias? Some are congenital (born with). Others are acquired. These come from any activity that increases the pressure in the abdomen. Examples include coughing, sneezing, straining to void/defecate, or heavy lifting. Why should I fix my hernia? Hernias can cause symptoms (pain), but the majority of patients have a painless lump/bulge. Pain before hernia surgery can indicate a problem and should prompt an office or ER visit. Hernias can incarcerate, get stuck out, which can be an emergency. What happens to the hernia if I do not have surgery? Generally the hernia gets bigger with time. The generally will not go away with surgery. It may turn into an emergency. How is the hernia fixed? The goal is to close the hole. This is done either with or without mesh. Mesh is stronger, but if it gets infected will have to be removed. It can be fixed with open or laparoscopic (small incisions and camera) technique. What are the advantages and disadvantages of the techniques? The open technique is the standard. This can be a shorter operation, with less chance of the hernia coming back. Laparoscopic hernia surgery has higher risks at the time of surgery, but traditionally has less postoperative pain. Do women get hernias? Yes. Women get all the same types of hernias with varying frequencies. How much pain will I have after surgery? Pain is different for everyone. Local anesthesia may be used during anesthesia which may work for several hours. Pain usually peaks within 24 hours after surgery then gets better gradually. Do I need a dressing (gauze) on the wound/incision? The incision (cut) is usually covered with surgical glue. Cover with clean dry gauze and change daily or as needed if it is draining fluid. Why do I feel a thick area under the incision? It is normal to feel a thick ridge of tissue at the incision site. This is healing tissue. Why is the area swollen? Tissue trauma from surgery will cause swelling that can take months before it resolves completely. Swelling after a few months should prompt an office follow up. Why do I have scrotal/penile swelling? Blood/fluid from the surgery can pool down in the scrotum/base of the penis. Occasionally there can be bruising (black and blue marks) in these areas. Why is fluid draining from the wound? Occasionally fluid will drain from surgical wounds. If this happens, cover the wound with clean dry gauze and change daily, or as needed. Do not get it wet. If it is draining then fluid could go in the wound. Make an office appointment to be seen. If there is significant redness on the wound, pain or fever then go to the emergency room if the office is closed. What diet should I be on? Usually a regular diet is ok after hernia surgery. The anesthesia can cause nausea/vomiting for a day or so. If this is the case then please drink liquids until this improves. If it does not improve in a day or two then please go into the office (or ER if after hours). What activity should I do after surgery? Walking is good, but do not overdue it. No heavy lifting (20 pounds) for 4 weeks for inguinal/femoral hernias and 8 weeks for ventral/ umbilical. Ask your surgeon for details. When should I follow up? Generally one week after surgery. Earlier follow up any problems develop (fever of 101 or greater, redness, fluid draining. The first follow up may be with our assistants, please come back to see the surgeon if you have questions or need further follow up. I have problems urinating, what should I do? Some people will develop urinary retention, the inability to urinate, after surgery. If you have not urinate in over 8 hours, and feel that you need to and are not able to then a visit to the emergency room may be necessary. What are the risks of surgery? Risks include but are not limited to bleeding, infection, injury to other structures (vessels, intestines, nerves), need for further surgery, recurrent hernia, heart attack, stroke, DVT, PE, chronic pain, change in size/location of testicle in scrotum. What are the risks of not having surgery? The contents in the hernia could get incarcerate, stuck, cutting off the blood supply to the contents (in many cases the intestines). How long does this skin glue last? If the surgical area is kept clean, dry and not scrubbed it can last for weeks. If it is still on after two weeks then you can be more aggressive about getting it off. If it comes off early (less than a week) then the wound may open or look as good long term. What type of anesthesia will be used at surgery? The majority of the time a complete (general) anesthesia is used. Lesser, sedation/local, can be used if needed based on medical conditions? Should I take any medications after the surgery? Yes. A stool softener is recommended. Pain medications are used as needed. Should I stop any of my medications before surgery? Any medication that interferes with bleeding should be stopped. Please ask your general doctor/cardiologist (or the prescribing doctor) if it is ok to stop these medications. Examples include but are not limited to aspirin, plavix, coumadin. All over the counter supplements should be stopped 2 weeks before surgery as well. Should I shave the area before surgery? No. The area may be shaved be the team on the day of surgery. Shaving at home before the surgery will increase infection risks? How long is the operation? Most umbilical (belly button) and inguinal hernia (groin) operations take about 1 hour. Expect to spend 1 -2 hours in recovery and most patients go home the same day of surgery. Complicated abdominal wall hernia or recurrent hernias can take longer up to several hours. What are the risks of hernia surgery? Hernia surgery is considered safe and low risk, however risks include but are not limited to bleeding, infection, and infection of the mesh requiring a second operation to remove the mesh. Nerve injury in the area may result in numbness and/or chronic pain. Generally these nerves are not involved with sexual function. Further risks include recurrence, bowel injury, vas deferens injury (vasectomy), and spermatic cord injury (injury to the testicle). Where do I show up and when? The office will instruct you where and when to show up for surgery. What is mesh? Why is it used? Mesh is a plastic material (usually polypropylene) that looks just like a window screen. It helps reinforce hernia repairs as tissue grows into it. It significantly reduces the chance for recurrence or failure. It incorporates into tissues and is usually no perceivable. When can I shower? If your surgeon used skin glue you can shower the next day. Do not scrub glue or soak the wound. The glue will fall off in 2-3 weeks. You can remove it in three weeks if it still there. If there are staples, no showering for 3-4 days as long as it is dry and not draining. If there are steri-strips shower in 2-3 days if the wound is otherwise dry and not draining. When can I work or drive? Most people can drive and work in 1 week. The criteria for driving are that you are not taking any narcotic pain medication and you can look over your shoulder and bend over to drive safely. Are there any activity restrictions? For inguinal and umbilical hernia operations, patients can and should walk the next day and stairs are okay. No heavy lifting more than 20lbs for 4 weeks. Light jogging and the exercise bike are okay after 2 weeks. Sexual activity is safe after 2 weeks if healing is otherwise progressing normally. If there is any pain or discomfort wait a total of 4 weeks. In general full activity can be resumed in 4 weeks. Some large hernias require 8 weeks before full activity. Is bruising normal? Yes, some bruising and swelling is expected and is normal. If this is expanding or getting larger then call your surgeon. Do I need to have stitches removed? No, almost all stitches are under the skin and will absorb in time. They do not need to be removed. When should I make a follow up appointment? Call to make a follow up appointment with our medical staff in 7-10 days after surgery. Most hernia patients follow up with our medical assistants unless there is a problem. Surgeons are always available for appointments if necessary. The staff is very prepared and well trained to handle almost all post op issues. How will I know if I have an infection? Infections are rare. They generally present with expanding wound redness a few days after surgery and can present even weeks later. Post op redness is normal and usually resolves in a few days. If it does not resolve or redness resolves then recurs return to the officer earlier. Some drainage is normal but increasing drainage or persistent drainage should also prompt earlier evaluation. What should I do if I am constipated? Constipation can happen after surgery. Several options for treatment include milk of magnesia, fleet enemas, Miralax, prune juice, mineral oil. Drink plenty of water and eat a high fiber diet. Metamucil, Citrucel, Benefiber can also be helpful to treat and prevent constipation. If these treatments are not working please call the office. Links Additional Abdominal Surgery Information Inguinal hernia Umbilical hernia Medline Plus (research questions about diseases and surgery) Back to Top Skin and soft tissue FAQ's
How is the wound closed? How long the sutures/staples stay in place? How long does the tape/glue stay in place? What activity may I do? What if fluid is draining from the wound? Skin and Soft tissue Links How is the wound closed? If there is not tension the wound may be closed with dissolving sutures and either tape or glue on the skin. Otherwise, there will be staples or sutures on the skin. How long the sutures/staples stay in place? This will vary depending on the body location and patient factors, but usually between 10-14 days. How long does the tape/glue stay in place? The glue will last from 1-3 weeks, depending on how much mechanical forces rub it off and how fast the skin sloughs. Do not pick at the glue and keep it clean and dry. If it is still on after 3 weeks then it may be peeled off. The tape (steri-strips) should stay on for 1-2 weeks. Cut the edges as they lift off. Remove after 3 weeks if still in place. What activity may I do? No heavy lifting or strenuous activity for 2-3 weeks. What if fluid is draining from the wound? Cover with clean dry gauze and change daily or as needed. If there is a significant amount then contact the surgeon. Skin and Soft tissue Links excisonal biopsy Medline Plus (research questions about diseases and surgery) Back to Top Vascular Surgery FAQ'sAbdominal Aortic Aneurysm FAQ'sWhat is abdominal aortic aneurysm (AAA)? What are the symptoms? What causes an abdominal aortic aneurysm? What tests will I need? How is an abdominal aortic aneurysm treated? What is abdominal aortic aneurysm (AAA)? 
The abdominal aorta supplies blood to the lower part of the body. When a weak area of the abdominal aorta expands or bulges, it is called and abdominal aortic aneurysm (AAA). Aneurysms are a health risk because they can burst causing severe internal bleeding, which can cause death. Less commonly, AAA can cause blood clots. What are the symptoms?
What causes an abdominal aortic aneurysm? Aneurysms are likely caused by inflammation in the aorta, which may cause its wall to weaken or break down. It may also be caused by atherosclerosis (fatty deposits built up in the artery) or risk factors such as high blood pressure and smoking, being a male over 60 years old, and having an immediate relative, such as a mother or brother, who has had an AAA. Your risk also increases with age. What tests will I need?
Your physician will help decide which option is best for you. Back to Top Surgical Aneurysm Repair and Endovascular Stent Graft FAQ's
What is a surgical aneurysm repair? What is an endovascular stent graft? How do I prepare? When do I need aneurysm repair? Am I eligible for endovascular stent graft? Am I at risk for complications? What happens during surgical aneurysm repair? What can I expect after surgical aneurysm repair or endovascular stent grafting? Are there any complications? What can I do to stay healthy? What is a surgical aneurysm repair? 
An aneurysm is an enlarged and weakened section of an artery. It is a serious health concern, because as the aneurysm increases in size, it can rupture. Besides rupturing, aneurysms carry another risk. Blood clots can form in an aneurysm and block blood flow to parts of your body. Although aneurysms can involve other arteries, most aneurysms occur in your aorta, which is the largest artery in your body. It runs from your heart through your chest and abdomen. More than one method to repair aneurysms is available. These include surgical, sometimes called "open" aneurysm repair, and endovascular, sometimes called "stent graft" aneurysm repair. Not all aneurysms need immediate treatment. If your aneurysm is small and not causing symptoms, your physician might recommend "watchful waiting," which means monitoring your aneurysm for signs of problems, such as enlargement. When an aneurysm causes symptoms or grows to a size that it can threaten your health, your physician might recommend surgical aneurysm repair. What is an endovascular stent graft? 
An endovascular stent graft is a tube composed of fabric supported by a metal mesh called a stent. It is most commonly used to reinforce an aneurysm. The stent graft is designed to seal tightly with your artery above and below the aneurysm. The graft is stronger than the weakened artery and it allows your blood to pass through it without problems. Endovascular stent graft repair is designed to help prevent an aneurysm from bursting. How do I prepare? As part of your physical exam, your physician will gently feel the aneurysm through skin over the suspected aneurysm and listen to your arteries through a stethoscope. Next, your physician may order some tests to measure the size of the aneurysm and determine its location such as:
Your physician may schedule you for surgical aneurysm repair if your aneurysm grows to a certain size, depending on where it is in your body, or if your aneurysm grows quickly. You may need it in an emergency if your aneurysm is about to rupture or burst or it has already ruptured. Am I eligible for endovascular stent graft? You may be eligible for elective (non-emergency) endovascular stent grafting if your aortic aneurysm has not ruptured, is large enough (5 centimeters, about 2 inches, wide or more), and you have a long enough area of normal artery for the stent graft to attach securely. Endovascular stent grafting may be a good option if your risk for conventional surgical aneurysm repair is increased because of other illnesses you might have. Am I at risk for complications? Serious health problems, which may be more likely in some individuals especially if they are very elderly, may increase the chances of having complications during aneurysm surgery. Other factors that may increase your chances of complications include:
You will be given anesthesia to eliminate pain during your aneurysm operation and your vascular surgeon will make an incision in your skin and muscle over the artery with the aneurysm. Once your surgeon exposes the aneurysm site, he or she will clamp the artery above the aneurysm to stop blood from flowing through the area. Your surgeon next opens the aneurysm and removes the clotted blood and plaque deposits. He or she may then cut through the wall of the weakened artery and open it like a butterfly. He or she may then insert a graft that is the same size and shape of your healthy artery. Your surgeon will attach one end of this graft by sewing it to the healthy artery just above where the aneurysm begins and sewing the other end to your normal artery below the end of the aneurysm. Another less common option is for your surgeon to attach a fabric patch to the artery wall to decrease its size and strengthen it. During endovascular stent grafting, your vascular surgeon threads a guide wire into your femoral artery through an incision and advances it to the aneurysm. Usually your vascular surgeon will perform angiography through the catheter to insure correct placement of the endovascular stent graft. Then, a compressed form of the graft is inserted through a larger catheter, called a sheath, and the guide wire carries so it can move through your blood vessels. When the graft has reached the aneurysm site, your physician withdraws the sheath, leaving the graft in place. The graft expands to fit snugly against the walls of your artery. What can I expect after surgical aneurysm repair or endovascular stent grafting? Depending on the location of your incision and your general health, you may need to stay in the hospital for about 2 to 10 days until you are recovered enough to go home. Your physician or vascular surgeon will give you the special instructions you need to follow after the surgery, such as not lifting anything more than 10 to 15 pounds, until your incision heals adequately. Periodically, depending upon its location, your physician may schedule you for an imaging study to make sure that your aneurysm is not redeveloping and that the graft, patch, or clips are functioning correctly. You will probably undergo imaging tests every few months then yearly if your aneurysm is shrinking and no problems are found. You may require more frequent imaging tests if potential problems require closer monitoring. Are there any complications? 
Less serious complications that you may experience following aneurysm surgery include swelling, respiratory or urinary infections, or infections at the incision site. More serious complications that you may experience include:
What can I do to stay healthy? Lowering your blood pressure and lowering your cholesterol may reduce your risks of developing another aneurysm or associated heart or vascular disease. Other recommended changes include:
Angioplasty and Stenting FAQ's
What is angioplasty and stenting? How do I prepare? Am I a candidate for angioplasty and stenting? Am I at risk for complications during angioplasty and stenting? What happens during angioplasty and stenting? What can I expect after angioplasty and stenting? Are there any complications? Serious, but unusual complications What is angioplasty and stenting? During an angioplasty, your vascular surgeon inflates a small balloon inside a narrowed blood vessel. The balloon helps to widen your blood vessel and improve blood flow. After widening the vessel with angioplasty, your vascular surgeon sometimes inserts a stent, a tiny metal mesh tubes that support your artery walls to keep your vessels wide open. How do I prepare? Your physician will order tests to show how much plaque has built up in your arteries. These tests include: Pulse volume recordings (PVRs), duplex ultrasound, magnetic resonance angiography (MRA), computed tomography (CT) scan or angiogram Usually, your vascular surgeon will ask you not to eat or drink anything several hours before your procedure and may ask you to stop some medications. If you have any allergies to contrast dye, iodine or shellfish, you should tell your vascular surgeon at this time. Before your procedure, your physician may order tests to check your kidney function as well as your blood's ability to clot. Am I a candidate for angioplasty and stenting? You may be a candidate for angioplasty and stenting if you have moderate to severe narrowing or blockage in one or more of your blood vessels. If you have extremely hard plaque deposits, blockages that contain blood clots or a large amount of calcium, extensive or particularly long blockages, blood vessel spasms that don't go away, or complete blockages that cannot be crossed with the catheter, you probably are not a good candidate for angioplasty. Am I at risk for complications during angioplasty and stenting? Complications to angioplasty and stenting may include reactions to the contrast dye, weakening of the artery wall, bleeding at the access puncture site in the vessel or the angioplasty site, re-blocking of the treated artery, and kidney problems. Plaque particles may break free during the angioplasty procedure and can cause blockages. If you have diabetes or kidney disease, you may have a higher risk of complications from the contrast dye, such as kidney failure. People with blood clotting disorders also may have a higher risk of complications from the procedure. What happens during angioplasty and stenting? 
Your physician will numb your skin and then make a small cut to reach the artery. Your vascular surgeon then inserts a guide wire or a guide catheter into your artery. Using a type of x ray that projects moving pictures on a screen, your physician guides the catheter through your blood vessels. Next, your vascular surgeon will insert a deflated balloon catheter to the narrowed section of your artery. He or she inflates the balloon until the narrowed area of the artery is widened. You vascular surgeon may need to use a stent to brace the artery open after angioplasty. A stent is a tiny mesh tube that looks like a small spring. Your vascular surgeon guides the stent through your blood vessels to the place where the angioplasty balloon widened your artery. The stent remains in place to support the walls of your artery. Your artery walls grow over the stent, preventing it from moving. A new type of stent is coated with drugs which may help prevent scar tissue from forming inside a stent. Once your vascular surgeon finishes angioplasty and stenting, he or she removes all of the catheters from your body and presses on the puncture area for 15 to 30 minutes to prevent bleeding. Sometimes, instead of pressing, your physician may close the area with a device that functions like a tiny cork, or he or she may use stitches. Angioplasty and stenting usually takes between 45 minutes and 3 hours. What can I expect after angioplasty and stenting? Usually, you will stay in bed for 6 to 24 hours after your angioplasty. During this time, your vascular surgeon and the hospital staff closely monitor you for any complications. You may have to hold your leg or arm straight for several hours. If you notice leg pain that lingers or gets worse, a fever, shortness of breath, an arm or a leg that turns blue or feels cold, and problems around your access site, such as bleeding, swelling, pain, or numbness after your surgery, tell your physician immediately. After you return home, your vascular surgeon will give you instructions about everyday tasks. For example, you should not lift more than about 10 pounds for the first few days after your procedure. You should drink plenty of water for 2 days to help flush the contrast dye out of your body. You can usually shower 24 hours after your procedure, but you should avoid baths for a few days. Your physician may prescribe aspirin or other medications that thin your blood to help prevent clots from forming on your stent. Your physician may also ask you to follow an easy exercise program, like walking. You will be asked to schedule a time to see your physician after the procedure. At this appointment, your physician may check your blood to make sure your medications are at the right dosage. He or she may also use tests to see how blood is flowing through your treated artery. Are there any complications? Serious complications are unusual following angioplasty and stenting but can occur. Less serious complications include bleeding or bruising where your vascular surgeon inserted the catheters. Sometimes, the hole created by the catheter does not completely close. This can create a false channel of blood flow. Rarely, an abnormal connection can form between an artery and a vein at the place where the catheter was inserted. These problems usually go away. However, if you have any serious symptoms, your vascular surgeon can treat you. As more time passes after your angioplasty and stenting, restenosis becomes more likely. Stents, especially drug-coated stents, may reduce this risk. However, in some cases, you may need a repeat angioplasty or a bypass surgery if a restenosis develops. Serious, but unusual complications include:
Aortoiliac Occlusive disease FAQ's
What is aortoiliac occlusive disease? What are the symptoms? What causes aortoiliac occlusive disease? What tests will I need? How is aortoiliac occlusive disease treated? What is aortoiliac occlusive disease? 
Aortoiliac occlusive disease occurs when your iliac arteries become narrowed or blocked. Your arteries are normally smooth on the inside, but as you age, a sticky substance called plaque can build up in the walls of your arteries. As more plaque builds up, it causes your arteries to narrow and stiffen. When your iliac arteries narrow or become blocked, your legs may not receive the blood and oxygen they need and it can cause pain. In severe cases, sores or gangrene can develop, which can result in losing a limb. What are the symptoms? Early signs:
Hardening of the arteries is the main cause of aortoiliac occlusive disease. Risk factors include smoking, high cholesterol, high blood pressure, obesity, and family history of heart disease. Rarely, Takayasu's arteritis can cause inflammation and blockages, but usually only affects young Asian women. What tests will I need? 
Ankle Brachial Index (ABI) First, your physician measures your blood pressure in your ankle and in your arm. They will compare the two numbers to determine your ABI. If your ankle pressure is half your arm pressure (or lower), your leg arteries are probably narrowed. Doppler Ultrasound 
Doppler ultrasound is another test that uses high-frequency sound waves that bounce off of blood cells and blood vessels to show blood flow and problems with the structure of blood vessels. This test better identifies specific arteries that are blocked. Angiography There are three tests that may be performed: contrast arteriography, CT angiography (CTA), and MR Angiography (MRA). In contrast arteriography you physician injects a contrast dye into your arteries and then takes x-ray images. This test finds the exact location and pattern of blockages. The dye is later passed from your body through your kidneys. If a blockage is identified and is appropriate for treatment by angioplasty and a stent, this procedure may be carried out at the same time. CTA and MRA are scans that are specifically dedicated to evaluating your blood vessels. How is aortoiliac occlusive disease treated? Lifestyle Changes
Angioplasty. If lifestyle changes and medications do not improve your aortoiliac occlusive disease, your physician may recommend angioplasty to improve your leg circulation. During this procedure a catheter is inserted into the vessel and a balloon is used to widen the artery. A stent may be placed in order to keep the artery open.
Surgery. Surgical bypass creates a detour around the blocked artery. A graft is attached to the aorta above the blockage and attached to an area of the iliac arteries that have adequate blood flow.  
Endarterectomy is another surgical option in which the plaque causing the blockage is removed from the artery. Your physican will help decide which option is best for you. Back to Top Carotid Endarterectomy FAQ's
What is carotid endarterectomy? How do I prepare? Am I eligible for carotid endarterectomy? Am I at risk for complications during a carotid endarterectomy? What happens during a carotid endarterectomy? What can I expect after a carotid endarterectomy? What can I do to stay healthy? Are there any complications? What is carotid endarterectomy? 
Carotid endarterectomy is one of the most commonly performed vascular operations for the treatment of carotid artery disease (CAD). In CAD plaque and clots can build up along the artery wall. If a clot or plaque blocks the blood flow to your brain it can cause a transient ischemic attack (TIA), also known as a mini-stroke, or an ischemic stroke, which can cause permanent brain damage, or death. A carotid endarterectomy is an operation during which your vascular surgeon removes plaque from your artery, which can restore blood flow and can help prevent a stroke. How do I prepare? 
Before your vascular surgeon performs a carotid endarterectomy, he or she may want to determine how much plaque has built up in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses painless sound waves to show your blood vessels and measure how fast your blood flows. It can also determine the location and degree of narrowing in your carotid artery. Other tests your vascular surgeon may use include:
You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing TIAs and are in reasonably good health otherwise. You may be eligible, but at a relatively increased risk, if you have:
Having had a stroke in the past increases your chances for complications. Other factors that may increase your chances for problems during a carotid endarterectomy, in addition to those conditions listed above, include:
You may either be put to sleep or a local numbing agent may be used. Your surgeon then makes the incision on one side of your neck to expose your blocked carotid artery. Next, your surgeon temporarily clamps your carotid artery to stop blood from flowing through it. During the procedure, your brain receives blood from the carotid artery on the other side of your neck or the artery will be temporarily bypassed. He or she then makes an incision directly into the blocked section. Next, your surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque. After removing the plaque, your surgeon stitches your artery, removes the clamps or the bypass, and stops any bleeding. He or she then closes your neck incision and the procedure is complete. Often, a patch is used to widen the artery as part of the procedure. The procedure takes about 2 hours to perform. What can I expect after a carotid endarterectomy? After surgery, you may stay in the hospital for 1 to 2 days. After you go home, your physician may recommend that you avoid driving and limit physical activities for several weeks. You can usually begin normal activities again several weeks after the operation. If you notice any change in brain function, severe headaches, or swelling in your neck, you should contact your physician immediately. Are there any complications? A stroke is one possible complication following a carotid endarterectomy, but the risk is very low. Another unusual complication is the re-blockage of the carotid artery, called restenosis, which may occur later, especially if you continue to smoke cigarettes. Temporary nerve injury, leading to hoarseness, difficulty with swallowing, or numbness in your face or tongue, is another uncommon, but possible, complication. This usually clears up in less than 1 month and usually doesn't require any treatment. What can I do to stay healthy? Although a carotid endarterectomy can reduce your risk of stroke by removing the offending plaque, it does not completely stop plaque from building up again in susceptible individuals. To minimize the chance of hardening of the arteries occurring again, you should consider the following changes:
Carotid Artery Disease, Stroke Transient Ischemic Attacks (TIA's)
| Our Physicians Kenneth Deck, MD FACS Nora Evans, MD FACS, FASCRS William Wallace, MD FACS Robert Duensing, MD FACS Blake Ashley, MD, FACS Wang Teng, MD Chirag Patel, MD FACS |
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