Emergency vascular surgery in space, on the moon, and mars: fundamental principles, technical protocols, and...

Human exploration of the Moon and Mars presents unprecedented challenges for emergency vascular surgery, as gravitational environments ranging from microgravity (0 g) to partial gravity on the lunar (0.16 g) and Martian (0.38 g) surfaces render conventional Earth-based techniques inadequate. This review synthesizes data from experimental physiology, ground-based analog models, parabolic flight testing, and theoretical hemodynamic modeling to establish a framework for vascular interventions across three gravitational regimes. In microgravity, electrosurgery is entirely inapplicable, necessitating the use of hermetically sealed fluid-filled surgical systems (AISS) for all vascular procedures. On the lunar surface, bipolar electrosurgery may be employed with strict limitations, including mandatory smoke aspiration, reduced power output, and limited activation time. Mars, with 0.38 g, most closely approximates Earth conditions, allowing standard surgical techniques with minor modifications. Differentiated technical protocols are proposed for five critical vascular emergencies: peripheral arterial thromboembolism, ascending thrombophlebitis, aortic dissection, cerebral thrombosis, and coronary thrombosis. Endovascular approaches are prioritized due to their minimally invasive nature and reduced resource requirements. Gravity-independent hemostatic modalities (laser, ultrasonic, mechanical) represent strategic priorities for future mission planning. AISS is mandatory for microgravity and lunar operations, while artificial gravity through centrifugation substantially expands endovascular therapeutic options.