Resuscitative endovascular balloon occlusion of the aorta for retroperitoneal hemorrhage and shock after ipsilateral antegrade angioplasty with vascular closure device

Background: This retrospective study investigates the efficacy and safety of the novel Celt ACD® vascular closure device (VCD) following antegrade and retrograde common femoral artery (CFA) punctures for the treatment of peripheral artery disease in a challenging patient collective (e.g. calcifications, obesity, and anticoagulation). Methods: A total of 208 VCDs (i.e. 100 antegrade and 108 retrograde) were deployed between October 2019 and December 2020 in a tertiary referral interventional radiology department. Fifty-two devices were undersized in relation to the introducer sheath (up to 2 Fr). Technical success and VCD related complications were evaluated in the immediate post procedure period and the following 24 h clinically. In 68% of cases, additional duplex ultrasound was performed prior to discharge. Results: The overall technical success rate was 97%. Technical failures following antegrade approach were due to a too acute access angle (⩾60°), rendering it impossible to pass the applicator tip through the sheath lumen. A subgroup analysis of technical success pinpoints severe calcification as another key limiting factor in VCD use ( p = 0.004). Comparing equally sized with undersized device selection ( p = 0.196), direction of approach ( p = 0.265), and body mass index ( p = 0.184) proved to be insignificant. Five (2%, 5/208) major complications occurred: Four antegrade (i.e. one false aneurysm, one vessel laceration with retroperitoneal hemorrhage, two device migrations; 4%, 4/100) and one following retrograde access (i.e. >6 cm hematoma, 1%, 1/108)). Complications were successfully managed with manual compression or interventional procedures. Conclusions: The novel clip-based VCD proved to be effective with a low VCD related complication rate.

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Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽

10.1024/0301-1526.33.2.78 ◽

2004 ◽

Vol 33 (2) ◽

pp. 78-81 ◽

Cited By ~ 21

Author(s):

Thalhammer ◽

Aschwanden ◽

Jeanneret ◽

Labs ◽

Jäger

Keyword(s):

Current Literature ◽

Vascular Complications ◽

University Hospital ◽

Closure Device ◽

Ultrasound Guided ◽

Vascular Closure Device ◽

Device Use ◽

Arterial Stenoses ◽

The University ◽

Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

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Endovascular treatment of acute limb ischemia caused by an intravascularly deployed bioabsorbable plug of a vascular closure device

VASA ◽

10.1024/0301-1526/a000260 ◽

2013 ◽

Vol 42 (2) ◽

pp. 144-148 ◽

Cited By ~ 3

Author(s):

Daniel Maxien ◽

Barbara Behrends ◽

Karla M. Eberhardt ◽

Tobias Saam ◽

Sven F. Thieme ◽

...

Keyword(s):

Endovascular Treatment ◽

Limb Ischemia ◽

Closure Device ◽

Acute Limb Ischemia ◽

Vascular Closure Device

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First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery

10.1055/s-0040-1705487 ◽

2020 ◽

Author(s):

A. El-Sayed Ahmad ◽

S. Salamate ◽

M. Amer ◽

S. Sirat ◽

Ö. Akhavuz ◽

...

Keyword(s):

Minimally Invasive ◽

Valve Surgery ◽

Closure Device ◽

Vascular Closure Device ◽

Minimally Invasive Valve Surgery

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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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Aktuelle Ist-Analyse zur Situation des nichttraumatologischen Schockraummanagements in Deutschland

Notfall + Rettungsmedizin ◽

10.1007/s10049-020-00827-z ◽

2020 ◽

Author(s):

M. Michael ◽

S. Bax ◽

M. Finke ◽

M. Hoffmann ◽

S. Kornstädt ◽

...

Keyword(s):

Chest Compression ◽

Balloon Occlusion ◽

Kritisch Kranke Patienten ◽

Compression Device ◽

Kritisch Kranke ◽

E Mail ◽

Endovascular Balloon Occlusion

Zusammenfassung Einleitung In Notaufnahmen kommen bundesweit nichttraumatologische kritisch kranke Patienten zur Aufnahme. Zur Struktur, Organisation und Ausstattung des nichttraumatologischen Schockraummanagements ist bisher wenig bekannt. Mittels einer Umfrage sollte daher der Ist-Zustand analysiert werden. Methodik Durch die Arbeitsgruppe „Schockraum“ der Deutschen Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) wurde mittels E‑Mail den 420 ärztlichen Leiter*Innen des DGINA-Mitgliederregisters eine Onlineumfrage zugesendet. Zwei Wochen nach initialem Anschreiben erfolgte eine Erinnerung. Die Ergebnisse wurden in einer anonymisierten Datenbank extrahiert und ausgewertet. Ergebnisse Insgesamt lag die Rücklaufquote mit 131 verwertbaren Antworten bei 31 %. Die Umfrage erfasste Krankenhäuser der Basis- (24 %), erweiterten (39 %) und umfassenden Notfallversorgung (37 %). Korrespondierend zur Versorgungsstufe stiegen die jährlichen Patientenkontakte (21.000 vs. 31.000 vs. 39.000), die Monitorplätze in den Notaufnahmen (9 ± 4 vs. 13 ± 6 vs. 18 ± 10), die Betten der assoziierten Notaufnahmestationen (4 ± 5 vs. 10 ± 17 vs. 13 ± 12), die verfügbaren Schockräume (1 ± 1 vs. 2 ± 1 vs. 3 ± 1) und deren Größe (31 ± 16 vs. 35 ± 9 vs. 38 ± 14 m2) an. Hinsichtlich verschiedener Ausstattungsmerkmale (z. B. Röntgenlafette: 58 vs. 65 vs. 78 %, Computertomographie im Schockraum: 6 vs. 12 vs. 27 %) zeigten sich deutliche Unterschiede in Abhängigkeit von der Versorgungsstufe. Während Kühlungssysteme in 30 % in allen Versorgungsstufen vorgehalten wurden, fanden sich andere Ausstattungsmerkmale (z. B. Videolaryngoskopie: 65 vs. 80 vs. 86 %, Bronchoskopie: 29 vs. 22 vs. 45 %) und spezielle Notfallprozeduren (z. B. REBOA [„resuscitative endovascular balloon occlusion of the aorta“]: 3 vs. 5 vs. 12 %, ACCD [„automated chest compression device“]: 26 vs. 57 vs. 61 %) häufiger in höheren Versorgungsstufen. Schlussfolgerung Die vorliegenden Ergebnisse zeigen erstmals den Ist-Zustand der nichttraumatologischen Schockraumversorgung in verschiedenen Versorgungsstufen in Deutschland. Empfehlungen zu Ausstattungsmerkmalen für das nichttraumatologische Schockraummanagement müssen zukünftig formuliert werden.

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