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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Endovascular vein harvest: systemic carbon dioxide absorption
Andrew M Maslow1, Carl S Schwartz, Arthur Bert
1Department of Anesthesiology, Rhode Island Hospital, Providence, 02903, USA. amaslow@rcn.com
Journal of Cardiothoracic and Vascular Anesthesia
|June 6, 2006
Summary
Endovascular vein harvest (EDVH) causes significant carbon dioxide (CO2) absorption, leading to increased blood CO2 levels and altered hemodynamics. Difficult procedures exacerbate CO2 absorption and hemodynamic changes, requiring medical intervention.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Vascular Physiology
Background:
- Endovascular vein harvest (EDVH) utilizes carbon dioxide (CO2) insufflation for saphenous vein visualization and dissection.
- Understanding CO2 absorption during EDVH is crucial for managing patient hemodynamics.
Purpose of the Study:
- To assess the extent of systemic CO2 absorption during EDVH procedures.
- To correlate CO2 absorption with hemodynamic and procedural variables.
Main Methods:
- Prospective observational study involving 60 patients undergoing coronary artery bypass graft surgery.
- Comparison between 30 EDVH and 30 open-vein harvest groups.
- Collection of hemodynamic, procedural, and laboratory data pre-harvest, during harvest, post-harvest, and during cardiopulmonary bypass (CPB).
Main Results:
- EDVH significantly increased arterial CO2 (PaCO2) by 35% and decreased pH by 1.35%.
- Associated hemodynamic changes included increased heart rate, mean blood pressure, and cardiac output.
- Higher PaCO2 elevations during difficult EDVH correlated with greater heart rate increases and persisted during CPB, necessitating increased gas flows and vasopressor use.
Conclusions:
- EDVH leads to significant systemic CO2 absorption.
- Difficult EDVH procedures are associated with greater CO2 absorption and more pronounced hemodynamic alterations.
- Management of CO2 absorption and associated hemodynamic changes is essential during and after EDVH.
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