Vascular Surgery
Including peripheral vascular disease
How Is Climate Change Affecting Vascular Health?
It is now well established that changes in climate and air quality can worsen cardiovascular disease. Vascular surgeons specialize in treating arteries and veins.
One common condition they address is peripheral artery disease (PAD), caused by a build-up of fat in the artery walls. This process, called atherosclerosis, is exacerbated by rising outdoor air pollution. Additionally, diabetes, which also contributes to arterial and venous diseases and is becoming more common, is aggravated by climate change.
Consequently, more adults will require treatment for their blood vessels or face amputations if the disease progresses too far. Fluctuations in temperatures and reductions in air quality are linked to increased deaths from cardiovascular causes.
Temperature swings can increase the likelihood of aneurysm ruptures, another condition frequently treated by vascular surgeons. Poor air quality has also been proven to be associated with abdominal aortic aneurysms (AAA), a condition that can cause sudden death if left untreated.
Furthermore, extreme weather events raise the demand for trauma services, often requiring the expertise of vascular surgeons. Heatwaves and wildfires also worsen cardiovascular diseases.
How is Vascular Surgery Affecting Climate Change?
Healthcare overall is responsible for 5-10% of global emissions, with surgery being the most environmentally impactful part of medicine. Operating rooms consume more energy than other hospital rooms, and vascular surgeons require even more energy in specially designed ‘hybrid’ theatre rooms.
Surgery generates approximately 25% of all hospital waste, much of which comes from single-use items or hazardous materials that require significant energy for proper disposal. In addition to energy, surgery demands large volumes of water for cleaning surgical instruments.
Anaesthetic gases and volatile agents, essential for many operations, directly pollute the atmosphere as they are released from patients' lungs. Halogenated anaesthetic gases, such as desflurane and nitrous oxide, are significant contributors to climate change. There are alternatives to these gases which can be used.
A single endovascular aortic aneurysm repair (EVAR), a common operation performed by vascular surgeons, produces roughly 108kg of CO2 and 21kg of waste. This procedure also requires 67 single-use items produced in 24 different countries, alongside 19 different drugs and infusions.
The Green Theatre Checklist
The UK and Irish surgical colleges have come together to produce a comprehensive evidence based checklist to make surgery as sustainable as possible. Get your department involved to play its part!
Discussion Ideas with Patients and Colleagues
Patients:
"Keeping control of your health conditions, such as diabetes can help reduce your need for an operation. Eating more plant-based foods can help with this and reduce your environmental impact too."
Colleagues
"Has your unit signed the royal colleges Intercollegiate Green Theatre Checklist?"
"Have you ever thought what is the best way to reduce our carbon foot when operating, how about developing a green protocol for operations?
"How can we balance the need for single-use items in surgery for patient safety with the environmental impact of the waste they produce? Are there viable alternatives?"
Highest Impact Actions for Vascular Departments
Embed climate change and healthcare sustainability into education and governance
Introduce One-stop vascular clinics. They reduce the number of journeys that patients need to take
Reduce the number of single use surgical items for theatres
Optimise heating, ventilation and air conditioning systems (HVAC) and reduce flow rates when the theatre is not in use, such as overnight
Implement a waterless scrubbing protocol, saving around 2.7 million litres of water every year
For More Information
Check out the Centre for Sustainable Healthcare Surgical Care Sustainability Network to discuss ideas on making surgical care more sustainable