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Environmental Impact Of Vascular Surgery Fluoroscopy Digital Subtraction Angiography
Aidan Rowe1, Omar Moussa Pasha
1, David Turk
1, David P. Ebertz
2, Saideep Bose
1, Catherine Wittgen
1, Michael Williams
1, David Han
1, Matthew R. Smeds
1.
1Saint Louis University School of Medicine, St. Louis, MO, USA,
2Case Western Cleveland Medical Center, Cleveland, OH, USA.
OBJECTIVES: Hospitals are responsible for 4-5% of greenhouse gas production and are significant contributors to climate change. We sought to understand the contributions of vascular surgery to the carbon footprint of hospitals by examining emissions from fluoroscopy across common procedures.
METHODS: Vascular procedures at a tertiary hospital were surveyed retrospectively for fluoroscopy digital subtraction angiography (DSA) data. Six cohorts were identified: EVAR, TEVAR, TCAR, femoral endarterectomy with iliac intervention (FEMILIAC), endovascular CLTI revascularization (ENDO CLTI), and lower extremity bypasses. Fluoroscopy time (min), number of DSA runs, amplitude, and voltage were recorded and averaged, and subsequently power (kW) and energy (kWh) were calculated. Using a certified Greenhouse Gas Equivalencies Calculator, total carbon dioxide emissions (CO2) were estimated. Results were compared using Chi-squared analysis and logistical regression.
RESULTS: 121 procedures including 23 EVAR, 21 TEVAR, 20 TCAR, 20 FEMILIIAC, 18 ENDOCLTI, and 19 bypasses were identified. The lowest CO2 emissions were seen with bypasses (2.01kg CO2), compared with larger emissions seen in EVAR (41.11kg CO2) and TEVAR (40.99 kg CO2). Despite similar CO2 emissions in EVAR/TEVAR, there was increased fluoroscopy time with EVARs (18.01 min vs 11.29 min, p=0.023). TCAR and FEMILIAC had similar fluoroscopy times (5.33 min vs 8.88 min, p=0.152), while TCAR resulted in half the emissions (7.35kg CO2 vs 16.47 kg CO2, p=0.039). For all cases combined, CO2 emissions increased with fluoroscopy time (r
2=0.622).
CONCLUSIONS:Among common vascular procedures, CO2 emissions are highest in TEVAR and EVAR, with amounts equivalent to the emissions generated from 100 miles driven by an average car. Time of fluoroscopy is associated with energy utilization/CO2 emissions. Further study is needed to identify factors that may decrease vascular surgery’s carbon footprint.
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