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A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.

Aims

We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.

Methods

A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.

Results

Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.

Conclusion

EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.

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Acknowledgments

We would like to thank Mr. Jon Kimber for language revision.

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Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden

    T. M. Hörer, P. Skoog, A. Pirouzram, K. F. Nilsson & T. Larzon

Authors
  1. T. M. Hörer
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  2. P. Skoog
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  3. A. Pirouzram
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  4. K. F. Nilsson
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  5. T. Larzon
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Corresponding author

Correspondence to T. M. Hörer.

Ethics declarations

The study was approved by the Regional Ethics Committee and is part of the ongoing multicenter “ABOTrauma Registry” study (Clinical Trial Registration No. 134021). Detailed information can be found in the “Methods”.

Conflict of interest

Tal Hörer, Per Skoog, Artai Pirouzram, Kristofer Nilsson and Thomas Larzon wish to declare that they have no conflicts of interest. This work received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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Hörer, T.M., Skoog, P., Pirouzram, A. et al. A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review. Eur J Trauma Emerg Surg 42, 585–592 (2016). https://doi.org/10.1007/s00068-015-0574-0

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  • DOI: https://doi.org/10.1007/s00068-015-0574-0

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