Dooner, Jim (M.D.)
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 Thursday
 06/20/2013


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Surgery
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Post Surgery
Vein Ablation (EVLT) Vein Ablation (EVLT)
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Aneurysm Surgery Aneurysm Surgery
Carotid Endarterectomy Carotid Endarterectomy
Endovascular Aneurysm Repair (EVAR) Endovascular Aneurysm Repair (EVAR)



Post Surgery for Carotid Endarterectomy

The hospital stay is only the beginning of the recovery process. Much remains to be accomplished when one returns home. In fact, the planning for recovery should start well in advance of the surgical date. The rapidity of recovery varies tremendously in relationship to ones preoperative state of health, the magnitude of the operation and the amount of support one has upon returning home. The following are some guidelines to help to prepare for this process.

This procedure has become a critical part of stroke prevention strategy. The operation has evolved to a high level of success. Still there are potential problems. Approximately three percent of patients may have a stroke or die as a result of complications. The problem for which carotid endarterectomy is warranted tends to occur in a group of people from 60 years of age and on. Many patients have a history of smoking although not all do. Diabetes is common as is history of heart disease. All of these factors can have a bearing on the potential for complications and the completeness of recovery.

Pre operative considerations:

Drs. J. Dooner & S. Lee Stop smoking; continued smoking increases the chance of further vascular disease both in the operated artery as well as other areas. Coughing post operatively is uncomfortable and increases the risk of bleeding and swelling.
Drs. J. Dooner & S. Lee Stop Aspirin and Plavix one week preoperatively to reduce bleeding problems at the time of surgery.
Drs. J. Dooner & S. Lee If you have diabetes, ensure good control by diet and medication.
Drs. J. Dooner & S. Lee Continue to take all blood pressure medications as instructed.
Drs. J. Dooner & S. Lee Plan for your recovery period.

Post operative considerations:

Drs. J. Dooner & S. Lee The operation will take approximately 2 hours. Six hours will be spent closely monitoring blood pressure and other factors in the recovery room.
Drs. J. Dooner & S. Lee Our goal is to have people ready to go home within twenty four hours.
Drs. J. Dooner & S. Lee In 80% of cases this is attainable based on comfort and medical stability. In the other cases, temporary problems with blood pressure, heart rhythm and other factors may lead to a longer stay. These will be further regulated until discharge is considered safe.
Drs. J. Dooner & S. Lee At discharge, there are no sutures in the neck incision to remove unless you have been specifically instructed otherwise. The wound may be left open but a light (Mepore) dressing is suggested for comfort.
Drs. J. Dooner & S. Lee Shaving may be deferred for a few days but can be resumed quickly. Keep in mind, the area between the incision and the chin may be numb for some time so be careful.
Drs. J. Dooner & S. Lee In some cases a piece of vein is harvested from the ankle area to use as a patch for the operated artery. This incision, if present may have surgical clips or sutures that do need to be removed. The ideal time is 7-10 days post operatively and can be done by your family doctor, a home care nurse or your surgeon. It may be wise to make arrangements for this as soon as you get home. As mentioned, this patch is not always needed.
Drs. J. Dooner & S. Lee Be as active as comfort allows. Turning the head and looking up is uncomfortable in the first two weeks but steadily improves.
Drs. J. Dooner & S. Lee Showering and bathing may be resumed after two to three days.
Drs. J. Dooner & S. Lee Do not drive until a complete range of neck movement has been restored and you are no longer taking narcotic containing painkillers.
Drs. J. Dooner & S. Lee Continue to take all preoperative medications unless directed otherwise.
Drs. J. Dooner & S. Lee Continue on one aspirin a day. There is no universal agreement on the best dosage. Some people advocate a baby (81mg) aspirin daily while others suggest an adult (325mg) tablet. My preference is the adult simply because it is inexpensive and it works.

The chance of recurrence in the operated artery is small (less than 5%). Progression of trouble in the opposite carotid artery can occur more frequently so it is prudent to have a repeat ultrasound arranged at least yearly if not every 6 months.


Dr. Jim Dooner









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