Intermittent use of resuscitative endovascular balloon occlusion of the aorta in penetrating gunshot wound of the lower extremity

Trauma is the leading cause of non-obstetrical maternal death. A 19-year-old woman at 20 weeks’ gestation was brought to the emergency room after suffering a gunshot wound to the lower abdomen. Upon arrival, she was hemodynamically stable and imaging was obtained. CT revealed a rupture of the uterus with a partially extrauterine fetus, and the patient was immediately taken for an explorative laparotomy. Prior to the surgical start, the patient’s blood pressure declined and, subsequently, a resuscitative endovascular balloon occlusion of the aorta (REBOA) was placed. The fetus and placenta were delivered and both uterine arteries and the inferior epigastric artery were ligated. Following an unremarkable postoperative course, she was discharged on hospital day 17. The mainstay approach to trauma in pregnancy should be to utilize focused imaging techniques to assess extent of trauma and provide adequate circulation to vital organs. Aortic balloon occlusion may be considered as a viable strategy to enhance resuscitation.

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The utility of resuscitative endovascular balloon occlusion of the aorta for temporary hemostasis after extensive bilateral lower extremity injuries: A case report

Radiology Case Reports ◽

10.1016/j.radcr.2019.03.006 ◽

2019 ◽

Vol 14 (5) ◽

pp. 623-626 ◽

Cited By ~ 1

Author(s):

Takafumi Shinjo ◽

Yoshimitsu Izawa ◽

Nobutaka Watanabe ◽

Keiichiro Tominaga ◽

Chikara Yonekawa ◽

...

Keyword(s):

Case Report ◽

Lower Extremity ◽

Balloon Occlusion ◽

Lower Extremity Injuries ◽

Bilateral Lower Extremity ◽

Extremity Injuries ◽

Endovascular Balloon Occlusion

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Life over Limb: Lower Extremity Ischemia in the Setting of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

The American Surgeon ◽

10.1177/000313481808400650 ◽

2018 ◽

Vol 84 (6) ◽

pp. 971-977 ◽

Cited By ~ 4

Author(s):

Philip J. Wasicek ◽

William A. Teeter ◽

Shiming Yang ◽

Peter Hu ◽

Melanie R. Hoehn ◽

...

Keyword(s):

Lower Extremity ◽

Arterial Injury ◽

Balloon Occlusion ◽

Lower Extremity Injury ◽

Inhospital Mortality ◽

Tertiary Center ◽

Lower Extremity Ischemia ◽

Arteries And Veins ◽

Endovascular Balloon Occlusion ◽

Extremity Ischemia

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing maneuver used to decrease hemorrhage, and thus perfusion, below the level of aortic occlusion (AO). We sought to investigate lower extremity ischemia in patients who received REBOA. Between February 2013 and September 2016 patients at a tertiary center that received REBOA and survived more than six hours were enrolled. Thirty-one patients were identified, the mean ISS was 40 ± 14 and inhospital mortality was 39 per cent. Twenty received REBOA in zone 1 (distal thoracic aorta). Three (15%) developed lower extremity compartment syndrome (LECS) after zone 1 REBOA. Injury of iliofemoral arteries and veins was each associated with calf fasciotomies (both P = 0.005). A longer duration of AO at zone 1 was associated with calf and thigh fasciotomy (P = 0.046 and P = 0.048, respectively). Iliofemoral arterial injury was associated with thigh fasciotomy (P = 0.04). Eleven patients received REBOA in zone 3 (distal abdominal aorta). Five (45%) patients underwent fasciotomy; four (36%) due to LECS. Femoral arterial injury was associated with calf fasciotomies (P = 0.02). There was no association with sheath size or laterality and need for fas-ciotomy. Neither groin access for REBOA or AO solely caused limb loss or LECS. The contribution to distal ischemia by REBOA remains unclear in patients with lower extremity injury.

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Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i3.92 ◽

2019 ◽

Vol 3 (3) ◽

Cited By ~ 1

Author(s):

Emre Özlüer ◽

Çagaç Yetis ◽

Evrim Sayin ◽

Mücahit Avcil

Keyword(s):

Vaginal Bleeding ◽

Balloon Occlusion ◽

Emergency Physicians ◽

Pelvic Packing ◽

Gynecological Malignancies ◽

Life Threatening ◽

Successful Control ◽

Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

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AORTA Registry 7F vs 11-12 F access

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.79 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Reviewer Joseph DuBose ◽

Jonathan Morrison ◽

Megan Brenner ◽

Laura Moore ◽

John B Holcomb ◽

...

Keyword(s):

Ultrasound Guidance ◽

Balloon Occlusion ◽

Aortic Occlusion ◽

Severely Injured ◽

Distal Extremity ◽

Low Profile ◽

Transfusion Requirements ◽

Thrombotic Complications ◽

Device Use ◽

Endovascular Balloon Occlusion

ABSTRACT Introduction: The introduction of low profile devices designed for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) after trauma has the potential to change practice, outcomes and complication profiles related to this procedure. Methods: The AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was utilized to identify REBOA patients from 16 centers -comparing presentation, intervention and outcome variables for those REBOA via traditional 11-12 access platforms and trauma-specific devices requiring only 7 F access. Results:From Nov 2013-Dec 2017, 242 patients with completed data were identified, constituting 124 7F and 118 11-12F uses. Demographics of presentation were not different between the two groups, except that the 7F patients had a higher mean ISS (39.2 34.1, p = 0.028). 7F device use was associated with a lower cut-down requirement for access (22.6% vs. 37.3%, p = 0.049) and increased ultrasound guidance utilization (29.0% 23.7%, p = 0.049). 7F device afforded earlier aortic occlusion in the course of resuscitation (median 25.0 mins vs. 30 mins, p = 0.010), and had lower median PRBC (10.0 vs. 15.5 units, p = 0.006) and FFP requirements (7.5 vs. 14.0 units, p = 0.005). 7F patients were more likely to survive 24 hrs (58.1% vs. 42.4%, p = 0.015) and less likely to suffer in-hospital mortality (57.3% vs. 75.4%, p = 0.003). Finally, 7F device use was associated with a 4X lower rate of distal extremity embolism (20.0% vs. 5.6%, p = 0.014;OR 95% CI 4.25 [1.25-14.45]) compared to 11-12F counterparts. Conclusion: The introduction of trauma specific 7F REBOA devices appears to have influenced REBOA practices, with earlier utilization in severely injured hypotensive patients via less invasive means that are associated with lower transfusion requirements fewer thrombotic complications and improved survival. Additional study is required to determine optimal REBOA utilization.

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.78 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Kelvin Allenson ◽

Laura Moore

Keyword(s):

Maternal Death ◽

Motor Vehicle ◽

Operative Management ◽

Balloon Occlusion ◽

Motor Vehicle Accidents ◽

Gravid Uterus ◽

Intrauterine Pregnancy ◽

Vehicle Accidents ◽

Pelvic Hemorrhage ◽

Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death. The gravid uterus is at risk for injury, particularly during motor vehicle accidents. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma. We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

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Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.74 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Valentina Chiarini

Keyword(s):

Trauma Center ◽

Aortic Rupture ◽

Damage Control ◽

Aortic Injury ◽

Balloon Occlusion ◽

Traumatic Lesion ◽

Abdominal Aortic ◽

Aortic Injuries ◽

Accepted Practice ◽

Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

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Use of ER-REBOA to Reverse Traumatic Arrest After Non-Truncal Bleeding

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v2i1.33 ◽

2018 ◽

Vol 2 (1) ◽

Author(s):

M. Chance Spalding ◽

Matthew L Moorman ◽

John B Holcomb

Keyword(s):

Cardiac Arrest ◽

Balloon Occlusion ◽

Successful Case ◽

Endovascular Balloon Occlusion

We report a successful case of resuscitative endovascular balloon occlusion of the aorta (REBOA) to control hemorrhage in a patient with cardiac arrest secondary to non-truncal hemorrhage.

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Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v1i1.6 ◽

2017 ◽

Vol 1 (1) ◽

pp. 22-27

Author(s):

Edwin R Faulconer ◽

Rachel M Russo ◽

Anders J Davidson ◽

Meryl A Simon ◽

Erik S DeSoucy ◽

...

Keyword(s):

Lower Extremity ◽

Open Surgery ◽

Management Strategies ◽

Balloon Occlusion ◽

Vascular Injuries ◽

Endovascular Management ◽

Review Of The Literature ◽

Junctional Zone ◽

Endovascular Interventions ◽

Direct Pressure

Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

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