Photo Credit: AI

The following is a summary of “An Audit of Physical Waste and Fluoroscopy Energy Consumption in Vascular Surgery and Suggestions for the Future,” published in the March 2025 issue of the Journal of Vascular Surgery by Pasha et al.

Hospitals contribute significantly to global greenhouse gas emissions, accounting for an estimated 4–5% of total emissions worldwide, thereby playing a substantial role in climate change. This study aims to quantify the carbon footprint associated with vascular surgery by evaluating emissions generated from fluoroscopy energy use and physical waste across a range of common vascular procedures. A prospective audit was conducted on vascular operations performed at a single tertiary hospital to assess the physical waste produced, while a retrospective audit of additional cases was undertaken to evaluate energy consumption during fluoroscopy digital subtraction angiography (DSA). Parameters such as fluoroscopy duration, number of DSA runs, amplitude, and voltage were recorded, and corresponding power (kW) and energy (kWh) were calculated. 

Procedures were categorized into seven cohorts: endovascular aneurysm repair (EVAR), thoracic endovascular aortic repair (TEVAR), transcarotid artery revascularization (TCAR), carotid endarterectomy (CEA), femoral endarterectomy with iliac intervention, lower extremity bypass, and endovascular lower extremity revascularization (Endo CLTI). The U.S. Environmental Protection Agency’s certified Greenhouse Gas Equivalencies Calculator was used to estimate total carbon dioxide emissions (CO₂e). A total of 18 vascular procedures were analyzed for physical waste emissions, with lower extremity bypass generating the highest CO₂e output at 85.75 kg (95% CI: 71.4–100.2) and CEA producing the lowest at 57.22 kg (95% CI: 48.7–65.7). No significant correlation was found between operative duration and waste volume. Fluoroscopy-related emissions were assessed in 97 procedures, revealing that EVAR contributed the highest CO₂e emissions from DSA runs (41.11 kg, 95% CI: 28.82–53.40), while TCAR had the lowest (7.33 kg, 95% CI: 5.15–9.49). 

When analyzing CO₂e production relative to fluoroscopy time, TEVAR had the highest emission rate at 3.63 kg/min DSA, while TCAR had the lowest at 1.37 kg/min DSA. Although a direct linear correlation was not identified between operative time and CO₂e emissions from waste (r² = 0.099), a strong correlation was observed between fluoroscopy time and CO₂e emissions (r² = 0.76). On average, vascular procedures generated 108.47 kg of CO₂e emissions from combined waste and fluoroscopy, which is equivalent to the emissions produced by driving a standard gasoline-powered vehicle for approximately 278 miles. These findings underscore the need for targeted interventions to mitigate the environmental impact of vascular surgery. The observed correlation between prolonged fluoroscopy time and increased CO₂e emissions highlights opportunities to optimize intraoperative imaging techniques, minimize unnecessary fluoroscopy usage, and invest in more energy-efficient imaging devices. 

Additionally, improved tracking of energy output from medical imaging systems and strategic adjustments to intraoperative settings could contribute to reducing the carbon footprint associated with vascular surgery. These findings emphasize the necessity for sustainability initiatives in surgical practice, including waste reduction strategies and energy-conscious surgical protocols, to align with broader efforts aimed at decreasing healthcare-related environmental impact.

Source: jvascsurg.org/article/S0741-5214(25)00614-7/abstract