Hannah Burton (Bedford, UK) writes about a new study—recently documented in the European Journal of Vascular and Endovascular Surgery—on the fate of device packaging for endovascular aneurysm repair (EVAR).
Sustainable surgery is an ever-growing topic of interest due to the global threat of climate change. Little is published about waste production in the vascular community with seemingly minimal awareness of adaptations to create an environmentally positive impact. We must promote discussions and action advancements in our specialty whilst simultaneously protecting the environment and preventing compromise for future generations from achieving their goals.1
The full vascular burden cannot be solely targeted—this would be an unrealistic challenge. I have examined disposal of EVAR device packaging within my trust to highlight current issues. The growing demand for this type of repair and an expanding market of stent grafts inevitably results in a need for more packaging. Only once the concern is underlined can we generate future strategies.
Our review summarised that packaging for EVAR devices contained between four and seven elements. The majority of materials were classed as recyclable as per company representatives; however, no packaging displayed the universal recyclable symbol. Alongside the main-body and limb devices it is common practice to use supplementary equipment like sheaths, balloons and polymer injections, which require additional, essential packaging with three to five components. Any recyclables handled by scrub nurses are deemed medical waste as per local regulatory policy, and therefore the majority go to incineration, unnecessarily contributing socioeconomically and environmentally.
These results were astounding. The majority of packaging is recyclable yet regularly disposed of inappropriately or falls outside the local policy criteria. Additionally, there are redundant components including booklets which are an environmental burden. Remarkably this is only one segmental review of the vascular community’s workload and is likely translatable to other interventions and specialties. The introduction of minimally invasive surgery over the past 20 years has brought undeniable patient benefits yet brings more singleuse instruments, which are mistakenly viewed as more economical despite hidden expenses like disposal. Hence, we must reflect on current practices and adapt as clinical professionals synergistically with manufacturers. It appears there is lack of current regulations, absence of reprocessing of materials, deficiency of clear institutional waste sorting policies and absence of green teams. These simple strategies should be implemented nationwide initially to tackle the ever-pressing challenges. Inappropriate incineration causes harmful environmental byproducts alongside the financial burden of running such facilities so we hope to create a cultural and educational change alongside implementing real transformations.2
In conclusion, raising awareness that the growing endovascular device market is impacting carbon footprints is imperative. We must take the initiative at higher executive levels to engage in environmentally friendly disposal practices. We should follow and surpass the Intercollegiate Green Theatre Checklist, making this a prominent National Health Service (NHS) agenda.3 Manufacturers should amend processes for example using packaging from recycled materials. Similar papers are gradually emerging on this topic and given EVAR is a well-developed technique, the recognition of this aspect has been remarkably slow. We are already broadening collaboration with interested parties to improve sustainability outcomes without compromising clinical care for vascular patients and ultimately taking steps to help the environment and our healthcare system.
References
- Burton HLE, Chaudhuri A. Sustainability in Endovascular Practice: A Pilot Study on the Fate of Device Packaging for Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg. 2024 Jul 13:S1078-5884(24)00623-3. doi: 10.1016/j. ejvs.2024.07.019. Epub ahead of print. PMID: 39009109
- Zikhathile T, Atagana H, Bwapwa J, et al. A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment. Int J Environ Res Public Health. 2022;19:11967.
- Robinson P, Surendran K, Lim S, et al. The carbon footprint of surgical operations: a systematic review update. Ann R Coll Surg Eng. 2023;105: 692-708.
Hannah Burton is an ST5 vascular surgery trainee at Bedfordshire – Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust.
