What is the role of surgical procedures in the etiology of 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

Surgical procedures are the primary cause of VAE. Neurosurgical procedures, especially those performed in the Fowler (sitting) position, and otolaryngologic interventions are the two most common surgeries complicated by VAE. [5]  Note the following:

  • The incidence of mild or clinically silent VAE during neurosurgical procedures has been estimated to range between 10% in cervical laminectomy surgeries where the patients are in the prone position, and 80% during posterior fossa surgeries (eg, repair of cranial synostosis) where patients are placed in the Fowler position [2, 21, 22, 23, 24]
  • VAE poses a risk anytime the surgical wound is elevated more than 5 cm above the right atrium. [2] ; the presence of numerous, large, noncompressed, venous channels in the surgical field (especially during cervical procedures and craniotomies that breach the dural sinuses) also increase the risk of VAE
  • Entrainment of air/gas facilitated by the patient's intraoperative position causing VAE, may result from other surgical procedures, including craniofacial surgery, dental implant surgery, vascular procedures (eg, endarterectomies), liver transplantation, orthopedic procedures (eg, hip replacement, spine surgery, arthroscopy), lateral decubitus thoracotomy, genitourinary surgeries in the Trendelenburg position, and surgeries involving tumors/malformations with high degree of vascularity or compromised vessels, as in the context of trauma [1, 7]
  • A preliminary study by Longatti et al suggested that carbon dioxide field flooding (ie, carbox dioxide–enriched surgical microenvironment) reduces the hemodynamic effects of VAE occurring in the sitting position, which the investigators attribute to the better solubility and improved tolerance of the arterial carbon dioxide emboli compared to air emboli [25]

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