Partial Aortic Occlusion using Resuscitative Endovascular Balloon Occlusion of the Aorta (P-REBOA) in Ruptured Abdominal Aortic Aneurysm

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Fareed Cheema ◽  
Aksim Rivera ◽  
Amit Shah ◽  
Sheldon Teperman ◽  
Melvin E. Stone ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Hemorrhagic Shock ◽  
Balloon Occlusion ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Cardiovascular Collapse ◽  
Abdominal Aortic ◽  
Blood Pressure Goals ◽  
Endovascular Balloon Occlusion

Ruptured abdominal aortic aneurysm is often a fatal event without immediate intervention for the associated hemorrhagic shock and impending cardiovascular collapse. We report a case of a ruptured abdominal aortic aneurysm managed with partially occlusive resuscitative endovascular balloon occlusion of the aorta (P-REBOA) as a means to gain proximal control, tailor blood pressure goals, while allowing time to obtain access and repair the ruptured aneurysm.

The Use of Rapid Endovascular Balloon Occlusion in Unstable Patients with Ruptured Abdominal Aortic Aneurysm

2009 ◽  
Vol 4 (2) ◽  
pp. 74-79 ◽  
Author(s):  
Tine E. Philipsen ◽  
Jeroen M. Hendriks ◽  
Patrick Lauwers ◽  
Maurits Voormolen ◽  
Olivier d'Archambeau ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Balloon Occlusion ◽  
Open Group ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Valuable Treatment ◽  
Endovascular Balloon Occlusion ◽  
Tomography Scan

Objective To present our results and demonstrate advantages of rapid endovascular balloon occlusion (REBO) of the juxtarenal aorta in unstable patients with ruptured abdominal aortic aneurysm (rAAA). Methods Since 2006, all unstable patients with rAAA are immediately transferred to the operating room (OR). No computed tomography scan is performed once diagnosis is made on ultrasound examination. Instability is defined as systolic blood pressure less than 60 mm Hg, unconsciousness, cardiac ischemia, or intubation. Once arrived in the OR, a Reliant aortic balloon is introduced and inflated at the level of the renal arteries. Subsequently, an angiogram is made through the contralateral femoral artery in order to decide between open or endovascular repair (EVAR). Results Twelve patients with rAAA were defined as unstable. REBO was installed within 10 minutes after arrival in the OR. Aortic occlusion resulted in immediate hemodynamic stability. Five patients were suitable for EVAR. Seven patients had open repair. For these abdominal dissection was more careful since no instability was encountered. All patients survived the procedure except one. Mean stay on intensive care unit was 19.7 days for open group and 8.4 for EVAR. Conclusions REBO of the juxtarenal abdominal aorta by pc technique in unstable patients with rAAA resulted in a 17% 30-day mortality and a 100% 1-year event-free follow-up for survivors. With this technique, EVAR exclusion is still a valuable treatment. Exposure and decision making for the open group is easier to perform with less risk for additional damaging to neighboring structures during dissection since urgent cross-clamping is not necessary.

Hypotensive Hemostatis (Permissive Hypotension) for Ruptured Abdominal Aortic Aneurysm: Are We Really in Control?

Vascular ◽  
2007 ◽  
Vol 15 (4) ◽  
pp. 197-200 ◽  
Author(s):  
J. Adam van der Vliet ◽  
Dennis L. van Aalst ◽  
Leo J. Schultze Kool ◽  
Jan J. Wever ◽  
Jan D. Blankensteijn
Keyword(s):  
Blood Pressure ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Systolic Blood Pressure ◽  
Pressure Range ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Permissive Hypotension ◽  
Abdominal Aortic ◽  
Blood Pressure Range ◽  
Aneurysm Repair

The purpose of this study was to investigate whether a protocol for permissive hypotension was feasible for patients admitted with a ruptured abdominal aortic aneurysm (RAAA). It was aimed to limit prehospital intravenous fluid administration to 500 mL and to maintain systolic blood pressure at a range of 50 to 100 mm Hg following admission, using nitrates when indicated. The diagnosis of RAAA was confirmed with sonography, and all patients with uncontrolled hypovolemic shock immediately underwent open aneurysm repair (OAR). In all other cases, computed tomographic (CT) angiography was performed to determine the eligibility for endovascular aneurysm repair (EVAR). From January 1, 2004, to December 31, 2006, 95 patients with a suspected RAAA were admitted. In 77 patients, the diagnosis of RAAA was confirmed. Twenty-eight cases (36%) underwent OAR for uncontrolled hemodynamic instability. Following CT-angiographic evaluation, 25 of the remaining 49 cases were considered unsuitable for EVAR and subsequently underwent OAR. In 24 of 77 cases (31%), the RAAA was treated with EVAR. Preoperative systolic blood pressure recordings in EVAR patients showed median values (± SD) of 98 (± 34.7) mm Hg in the emergency department and 114 (± 26.2) mm Hg in the operating theater. The desired systolic blood pressure range of 50 to 100 mm Hg was reached in 11 of 24 cases (46%). In 13 of 24 cases (54%), a systolic blood pressure higher than 100 mm Hg was recorded for a period longer than 60 minutes. The 30-day mortality was 32 of 77 (42%), with 6 of 24 (25%) in the EVAR group and 26 of 53 (49%) in the OAR group. This is the first published series of RAAA in which a protocol of permissive hypotension has been adopted. The concept appeared to be feasible in the majority of cases. Protocol violations were sparse ( n = 5). Uncontrolled hypotension occurred in 36% (28 of 77) of all patients, and the desired systolic blood pressure range was achieved in 46% (11 of 24) of the EVAR patients.

scholarly journals Cerebral Embolism Following Attempted Balloon Occlusion of a Ruptured Abdominal Aortic Aneurysm.

1996 ◽  
Vol 25 (5) ◽  
pp. 337-339 ◽  
Author(s):  
Takafumi Tahata ◽  
Shigehito Miki ◽  
Yuichi Ueda ◽  
Hitoshi Ogino ◽  
Koichi Morioka ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Balloon Occlusion ◽  
Cerebral Embolism ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic

scholarly journals Ruptured abdominal aortic aneurysm: prognostic factors

2005 ◽  
Vol 4 (4) ◽  
pp. 321-326 ◽  
Author(s):  
Denise Rabelo da Silveira ◽  
Vanessa Prado dos Santos ◽  
Aline Faria Lamaita ◽  
Henrique Jorge Guedes Neto ◽  
Alvaro Razuk Filho ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Abdominal Aortic Aneurysm ◽  
Prognostic Factors ◽  
Aortic Aneurysm ◽  
Hospital Admission ◽  
Statistical Significance ◽  
Abdominal Mass ◽  
Previous History ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic

OBJECTIVE: To analyze the prognostic factors related to the mortality of ruptured abdominal aortic aneurysm. METHOD: Seventy-two patients who suffered ruptured abdominal aortic aneurysm and were operated in the period between 1976 and 2000 by the Vascular Surgery Unit of the Santa Casa de São Paulo - School of Medical Sciences were retrospectively analyzed. RESULTS: The descriptive analysis of the data shows a mean age of 67.93 years, with a standard deviation of 11.58, 32% female and 68% male. Of the total number, 28% had a previous history of aneurysm and 72% were not aware of the disease. Mean systolic blood pressure during hospital admission was 96.53 mmHg. Pain was present in 100% of the patients, as well as throbbing abdominal mass. In 93% of the cases the location of the aneurysm rupture was the retroperitoneum, 4% in the duodenum, and 2% in the free peritoneum. CONCLUSION: The prognostic factors related to mortality and morbidity that demonstrated statistical significance were: age, initial blood pressure at hospital admission, diuresis during surgery, volume infused, and creatinine levels.

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