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

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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Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2018-000262 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000262 ◽

Cited By ~ 10

Author(s):

Omar Bekdache ◽

Tiffany Paradis ◽

Yu Bai He Shen ◽

Aly Elbahrawy ◽

Jeremy Grushka ◽

...

Keyword(s):

Trauma Center ◽

Damage Control ◽

Balloon Occlusion ◽

Control Measures ◽

Scoping Reviews ◽

Level I ◽

A New Technique ◽

First Time ◽

Substantial Heterogeneity ◽

Endovascular Balloon Occlusion

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining popularity in the treatment of traumatic non-compressible torso bleeding. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic.MethodsCritical search from MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS were conducted from the earliest available dates until March 2018. Evidence-based articles, as well as gray literature at large, were analyzed regardless of the quality of articles.ResultsWe identified 1176 articles related to the topic from all available database sources and 57 reviews from the gray literature search. The final review yielded 105 articles. Quantitative and qualitative variables included patient demographics, study design, study objectives, methods of data collection, indications, REBOA protocol used, time to deployment, zone of deployment, occlusion time, complications, outcome, and the level of expertise at the concerned trauma center.ConclusionGrowing levels of evidence support the use of REBOA in selected indications. Our data analysis showed an advantage for its use in terms of morbidities and physiologic derangement in comparison to other resuscitation measures. Current challenges remain in the selective application, implementation, competency assessment, and credentialing for the use of REBOA in trauma settings. The identification of the proper indication, terms of use, and possible advantage of the prehospital and partial REBOA are topics for further research.Level of evidenceLevel III.

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Emergent Endoluminal Repair of Delayed Abdominal Aortic Rupture after Blunt Trauma

Journal of Endovascular Therapy ◽

10.1177/152660289800500207 ◽

1998 ◽

Vol 5 (2) ◽

pp. 134-137 ◽

Cited By ~ 6

Author(s):

Reinhard Scharrer-Pamler ◽

Johannes Görich ◽

Karl H. Orend ◽

Roman Sokiranski ◽

Ludger Sunder-Plassmann

Keyword(s):

Bacterial Contamination ◽

Aortic Rupture ◽

Good Health ◽

Aortic Injury ◽

Abdominal Injuries ◽

Hepatic Rupture ◽

Motorcycle Accident ◽

Endoluminal Repair ◽

Abdominal Aortic ◽

Aortic Injuries

Purpose: To report the emergency repair of a traumatic abdominal aortic rupture using endoluminal techniques. Methods and Results: A 25-year-old female sustained multiple head, chest, and abdominal injuries in a motorcycle accident. Six days after emergency treatment (including splenectomy and repair of a superficial hepatic rupture and lacerations to the stomach, small bowel, and colon), she became hemodynamically unstable. A massive retroperitoneal hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen and possibility of bacterial contamination, a self-expanding stent-graft was inserted transfemorally to repair the aortic injury. The patient recovered uneventfully and continues in good health with a patent endograft repair 2 years after treatment. Conclusions: This experience would support the efficacy of endograft implantation for emergent repair of trauma aortic injuries; however, proper facilities, an experienced interventional team, and an assortment of endografts and stents must be available.

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Ten-Year Follow-Up after Endovascular Repair of Traumatic Abdominal Aortic Rupture

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182087993 ◽

2011 ◽

Vol 6 (1) ◽

pp. 51-53

Author(s):

Stephen Nicholls ◽

Riyad Karmy-Jones

Keyword(s):

Endovascular Repair ◽

Aortic Rupture ◽

Graft Infection ◽

Aortic Injury ◽

Bowel Injury ◽

Operative Repair ◽

Abdominal Aortic ◽

Aortic Injuries ◽

And Migration

Blunt abdominal aortic injury is often associated with bowel injury that precludes operative repair because of the risk of graft infection. Endovascular repair has been reported but with limited follow-up. We present a case of a 15-year-old boy who underwent endovascular repair of blunt abdominal aortic rupture and whom we were able to follow up over a decade. Our experience with this case and three others, as well as the experience reported in the literature, suggests that endovascular repair is a reasonable option in the setting of concomitant bowel injury. The risk of over sizing, collapse, and migration may be less than that described for thoracic aortic injuries because there is no need to deploy the endograft across an angle.

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Case of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Use in Penetrating Abdominal Aortic Injury

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v1i1.12 ◽

2017 ◽

Vol 1 (1) ◽

pp. 53-57

Author(s):

Meryl A Simon ◽

Rachel M Russo ◽

Anders J Davidson ◽

Edwin R Faulconer ◽

Erik DeSoucy ◽

...

Keyword(s):

Aortic Injury ◽

Balloon Occlusion ◽

Injury Pattern ◽

Abdominal Aortic ◽

Life Saving ◽

Endovascular Balloon Occlusion

We present the successful utilization of REBOA in a case of penetrating abdominal aortic injury. This allowed for hemorrhagic control and exposure of a large aortic defect at the level of the celiac access, which otherwise would have been difficult to control in an open fashion. Although use in this specific injury pattern in the literature is limited, REBOA can be a life-saving maneuver.

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Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01592-x ◽

2021 ◽

Author(s):

Andreas Brännström ◽

Albin Dahlquist ◽

Jenny Gustavsson ◽

Ulf P. Arborelius ◽

Mattias Günther

Keyword(s):

Fluid Management ◽

Class Ii ◽

Balloon Occlusion ◽

Metabolic Effects ◽

Total Blood ◽

Crystalloid Fluid ◽

Vasopressor Support ◽

Abdominal Aortic ◽

Life Threatening ◽

Endovascular Balloon Occlusion

Abstract Purpose Pelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg. Methods 60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion. Results Cumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support. Conclusion Zone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

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