Purpose: To investigate the amount of gas released from Zenith thoracic stent-grafts using standard saline flushing vs the carbon dioxide flushing technique. Methods: 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. Results: 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). Conclusion: 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.
ChengDMartinJShennibH. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol. 2010;55:986–1001.
2.
MatsumuraJSMelissanoGCambriaRP. Five-year results of thoracic endovascular aortic repair with the Zenith TX2. J Vasc Surg. 2014;60:1–10.
3.
MurphyEHStanleyGAIlvesM. Thoracic endovascular repair (TEVAR) in the management of aortic arch pathology. Ann Vasc Surg. 2012;26:55–66.
4.
RohlffsFTsilimparisNDetterC. New advances in endovascular therapy: endovascular repair of a chronic DeBakey type II aortic dissection with a scalloped stent-graft designed for the ascending aorta. J Endovasc Ther. 2016;23:182–185.
5.
TsilimparisNDebusESOderichGS. International experience with endovascular therapy of the ascending aorta with a dedicated endograft. J Vasc Surg. 2016;63:1476–1482.
6.
GutscheJTCheungATMcGarveyML. Risk factors for perioperative stroke after thoracic endovascular aortic repair. Ann Thorac Surg. 2007;84:1195–1200.
7.
HaulonSGreenbergRKSpearR. Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg. 2014;148:1709–1716.
8.
LynchJERileyJB.Microemboli detection on extracorporeal bypass circuits. Perfusion. 2008;23:23–32.
9.
EohEJDerrickBMoonR.Cerebral arterial gas embolism during upper endoscopy. A A Case Rep. 2015;5:93–94.
10.
ZakhariNCastilloMTorresC.Unusual cerebral emboli. Neuroimaging Clin N Am. 2016;26:147–163.
11.
KahlertPEggebrechtHJanosiRA. Silent cerebral ischemia after thoracic endovascular aortic repair: a neuroimaging study. Ann Thorac Surg. 2014;98:53–58.
12.
KölbelTRohlffsFWipperS. Flushing technique to prevent cerebral arterial air embolism and stroke during TEVAR. J Endovasc Ther. 2016;23:393–395.
13.
KernsSRHawkinsIF.Carbon dioxide digital subtraction angiography: expanding applications and technical evolution. AJR Am J Roentgenol. 1995;164:735–741.
VallabhajosyulaPSzetoWY.Current paradigms in aortic arch repair: Striking the balance between open surgery and endovascular repair. J Thorac Cardiovasc Surg. 2015;150:1399–1400.
17.
WipperSLohrenzCAhlbrechtO. Antegrade side branch access in branched aortic arch endografts: a porcine feasibility study. J Endovasc Ther. 2013;20:233–241.
