title: Air Embolism During TEVAR: Carbon Dioxide Flushing Decreases the Amount of Gas Released from Thoracic Stent-Grafts During Deployment.
abstract: To investigate the amount of gas released from Zenith thoracic stent-grafts using standard saline flushing vs the carbon dioxide flushing technique.
  
  
  
  In an experimental bench setting, 20 thoracic stent-grafts were separated into 2 groups of 10 endografts. One group of grafts was flushed with 60 mL saline and the other group was flushed with carbon dioxide for 5 minutes followed by 60 mL saline. All grafts were deployed into a water-filled container with a curved plastic pipe; the deployment was recorded and released gas was measured using a calibrated setup.
  
  
  
  Gas was released from all grafts in both study groups during endograft deployment. The average amount of released gas per graft was significantly lower in the study group with carbon dioxide flushing (0.79 vs 0.51 mL, p=0.005).
  
  
  
  Thoracic endografts release significant amounts of air during deployment if flushed according to the instructions for use. Application of carbon dioxide for the flushing of thoracic stent-grafts prior to standard saline flush significantly reduces the amount of gas released during deployment. The additional use of carbon dioxide should be considered as a standard flush technique for aortic stent-grafts, especially in those implanted in proximal aortic segments, to reduce the risk of air embolism and stroke.
authors: 1 German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Fiona
authors: F
authors: Rohlffs
authors: 1 German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Nikolaos
authors: N
authors: Tsilimparis
authors: 1 German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Vasilis
authors: V
authors: Saleptsis
authors: 1 German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Holger
authors: H
authors: Diener
authors: 1 German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: E Sebastian
authors: ES
authors: Debus
authors: 1 German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors: Tilo
authors: T
authors: Kölbel
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004618:Embolism, Air / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008422:Materials Testing; D012307:Risk Factors; D015607:Stents; D007507:Therapeutic Irrigation / Q000379:methods*
chemical_list: D002245:Carbon Dioxide
keywords: air embolism; aorta; aortic aneurysm; carbon dioxide; endovascular procedures; endovascular technique; stroke; thoracic aorta; thoracic endovascular aortic repair