Carbon Dioxide Flushing Technique to Prevent Cerebral Arterial Air Embolism and Stroke During TEVAR

Abstract

Arterial air embolism is a potentially underappreciated problem of aortic endografting, especially in the proximal segments of the aorta. CO2 flushing may have the potential to reduce air embolization during TEVAR.

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

“…193 To minimize the risk of stroke, temporary carotid artery occlusion, filter placement and carbon dioxide flushing of the delivery system have been proposed. 193,194,200 For endovascular aortic arch repair, there are 2 general graft designs: fenestrated and branched arch endografts. Both designs are currently available as custom-made devices only, so a manufacturing time of between 4 and 8 weeks precludes their use in urgent and emergency situations.…”

Endovascular arch replacement with a dual branched endoprosthesis

“…This patient is part of our earliest experience, when device flushing with carbon dioxide was not routinely performed. Kölbel and co-authors reported in a group of 36 patients treated with ascending aorta or arch devices flushed with carbon dioxide, just one minor stroke in a patient with a highly calcified aortic arch (6). Of course, our sample is too small to reach statistical significance in determining the use of carbon dioxide as a protective factor in the prevention of air embolism-related neurologic events.…”

“…All patients received a LCCA-LSA bypass as first step. Endovascular step was carried out after a mean interval of 7 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] days. The LSA stump was always occluded by a vascular plug.…”

“…Moreover, there were no cases of cardiac, renal or access related complications, and no spinal cord ischemia. The mean postoperative length of stay for the five survivors was seven [4][5][6][7][8][9][10][11][12][13][14] days, including a mean intensive care unit stay of 1.5 [1][2][3]…”

Das thorakale Aortenaneurysma – Diagnostik und Behandlungsstrategien

“…Die Prävention eines perioperativen Schlaganfalls bei TEVAR, insbesondere bei weit in den Aortenbogen hineinreichenden Rekonstruktionen, steht ebenfalls besonders im Fokus. Das Risiko von Mikroembolien während der Manipulation im Aortenbogen, vor allem bei hoher Thrombuslast der Aorta (shaggy aorta) [15], aber auch das technisch bedingte Risiko von Luftembolien während der Freisetzung der Endoprothese, sind pathophysiologische Mechanismen, die primär für die Entstehung von Schlaganfällen verantwortlich sind [16]. Die Erfassung perioperativer Schlaganfälle in TE-VAR-Studien sowie die Etablierung von Techniken zur ▶ Abb.…”