Vascular Complications Secondary To REBOA Placement At A Level 1 Trauma Center
Amanda Tullos, MD, Sanjay Wunnava, Claudie Sheahan, MD, Amit Chawla, MD, Bruce Torrance, MD, Amadis Brooke, MD, Melissa Donovan, MD, Tapash Palit, MD, Malachi Sheahan, III, MD.
LSUHSC - Louisiana State University Health Science Center, New Orleans, LA, USA.
OBJECTIVES: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is designed to manage severe hemorrhagic shock. Popularized in medical care during military conflicts, the concept emerged as a lifesaving technique that is utilized around the United States. Literature on risks of REBOA placement, especially vascular injuries, are not well reported. Our goal was to assess the incidence of vascular injury from REBOA placement, risk factors associated with injury and the incidence of death among these patients at our institution.
METHODS: We performed a retrospective cohort study of all patients who underwent REBOA placement between September 2017 and June 2022 in our Level 1 Trauma center. The primary outcome variable was the presence of an injury related to REBOA insertion or use. Secondary outcomes studied were limb loss and mortality. Data were analyzed using descriptive statistics, Chi square and t-tests as appropriate for the variable type.
RESULTS: We identified 99 consecutive patients who underwent REBOA placement during the study period. The mean age of patients was 43 (13-84) and 67.7% (67/99) were males. The majority of injuries were from blunt trauma (79.8%, 79/99). Twelve of the patients (12.1%, 12/99) had a vascular injury related to REBOA placement that required emergent intervention. All but one of the injuries were identified within 4 hours of REBOA placement. The delayed repair was a pseudoaneurysm that was repaired 10 days following REBOA placement. The complications included local vessel injury 58.3% (7/12), distal embolization 16.7% (2/12), excessive bleeding requiring vascular consult 8.3% (1/12), pseudoaneurysm requiring intervention 8.3% (1/12) and one incident of inability to remove REBOA device (8.3%, 1/12). The repairs were performed by vascular surgery (75%, 9/12), interventional radiology (16.7%,2/12) and trauma surgery (8.3%, 1/12). There was no association of age, gender, race, and blunt versus penetrating injury to REBOA related complications. Mortality in this patient population was high (40.4%, n/99), but there was no association with REBOA related complications. Ipsilateral limb loss occurred in two patients, but both were related to their injuries and not to REBOA related ischemia. CONCLUSIONS: While vascular complications are not unusual there does not appear to be an association with limb loss or mortality if they are addressed promptly. Close coordination between vascular surgeons and trauma surgeons is essential in patients undergoing REBOA placement.
Back to 2023 Abstracts