What is venous air embolism (VAE)?

Updated: Dec 30, 2017
  • Author: Brenda L Natal, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
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Answer

Venous air embolism (VAE), a subset of gas embolism, is an entity with the potential for severe morbidity and mortality. It is a predominantly iatrogenic complication [1, 2] that occurs when atmospheric gas is introduced into the systemic venous system. [3]

In the past, VAE was mostly associated with neurosurgical procedures conducted in the sitting position. [4, 5] Subsequently, it has been associated with central venous catheterization, [3, 6, 7] scalp incision, [8] cervical spine fusion, [9] penetrating and blunt chest trauma, [10, 11, 12] high-pressure mechanical ventilation, [3] thoracocentesis, [1] hemodialysis, [3, 7, 13] and several other invasive vascular procedures.

VAE has also been observed during diagnostic studies, such as during radiocontrast injection for computed tomography (CT). [14, 15] The use of gases such as carbon dioxide and nitrous oxide during medical procedures and exposure to nitrogen during diving accidents can also result in VAE. [2] In addition, apparent cases of VAE resulting from pressurized, intravenous infusion of normal saline have been reported in professional football players. [16]

Many cases of VAE are subclinical with no adverse outcome and thus go unreported. Usually, when symptoms are present, they are nonspecific, and a high index of clinical suspicion for possible VAE is required to prompt investigations and initiate appropriate therapy.


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