Successful and Unsuccessful Blind Placement of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheters Through Damaged Arteries: A Report of Three Cases
Background: Patients who receive REBOA for temporization of exsanguinating hemorrhage may have occult injuries sustained to the iliac arteries or aorta which may pose increased risks in performing REBOA. There is a paucity of literature describing the successful blind placement of wires and/or catheters for REBOA through damaged vasculature.
Methods: Patients admitted between February 2013 and July 2017 at a tertiary center who had a successful or unsuccessful blind placement of a REBOA catheter or wire through a damaged iliac artery or aorta were included.
Results: Three patients were identified. Two patients had successful placement of the REBOA catheter; one sustained injury to the external iliac artery, and the other sustained injury to the abdominal aorta. Confirmation of catheter placement was obtained before balloon inflation; and the damaged vessels were identified upon immediate operative intervention. One patient had unsuccessful placement of the REBOA catheter during cardiac arrest despite accurate access of the common femoral artery (CFA).
Conclusions: Emergent, blind placement of wires and catheters past arterial injuries is possible. Physical exam and/or tactile feedback should alert the surgeon to the possibility of arterial injury and imaging confirmation should precede balloon inflation if at all possible to minimize risk of further vascular injury.