Saving lives and limbs: Challenges for the REBOA aficionado

Although the use of resuscitative endovascular balloon occlusion aorta (REBOA) has expanded management options among patients with noncompressible torso hemorrhage, risk procedural complications continues to elicit caution. this life-saving adjunct proven effective in carefully select patients, limb loss remains a dreaded complication that demands proper training, technique, and experience. Lower profile balloons have simplified arterial puncture possibly rate iatrogenic vascular injury sustaining desire for an alternative thoracotomy. Siracuse et al1Levin S.R. Farber A. Burke P.A. Brahmbhatt T.S. Richman A.P. Twomey K.E. al.The majority major amputations after are associated pre-admission trauma.J Vasc Surg. 2021; 74: 467-476Scopus (3) Google Scholar improved our understanding factors mortality REBOA. The study offers important insight recognizing amputation as pattern rather than procedure making key distinction evaluating procedure-related morbidity. further prospective analysis is warranted, National Trauma Data Bank demonstrated over 300 baseline injuries not REBOA appear be primary cause these trauma patients.1Levin It understand limitations modest granularity registry data. In retrospective analysis, amputated limbs were mangled at scene or had documented extremity injury. After excluding 11 traumatic amputations, only two seven no apparent previous five severe abbreviated scores, other details available determine why any performed. A pre-existing plausible explanation yet access site complications, dissection, prolonged time, thromboembolic events all aggravating circumstances can sabotage well-intended salvage effort. Despite some limitations, report rigorous, thoughtful, merit. Other investigators also studied incidence access-related meta-analysis groin found 13 studies total 424 patients. Overall, related femoral occurred 5.6% (24 424). was required 2.1% (9 424), which three cases (0.7%) considered related.2Manzano-Nunez R. Orlas C.P. Herrera-Escobar J.P. Galvagno S. DuBose J. Melendez J.J. al.A patients.J Acute Care 2018; 85: 626-634Crossref Scopus (35) Brenner al3Brenner M. Moore L. Teeter W. Hu P. Yang Wasicek al.Exclusive clinical experience lower device (REBOA).Am J 2019; 217: 1126-1129Abstract Full Text PDF (22) noted exclusive review 7-French system 60 included one iliac requiring stent graft, patch angioplasty, ruptures mostly from overinflation. Five performed immediately prehospital injuries, more efforts extremities unsuccessful.3Brenner tool when properly used part larger damage control will greatest chance success.4Bulger E.M. Perina D.G. Qasim Z. Beldowicz B. Guyette F. al.Clinical civilian systems USA, 2019: joint statement American College Surgeons Committee on Trauma, Emergency Physicians, Association Medical Services Physicians Technicians.Trauma Surg Open. 4: e000376Crossref PubMed (82) most temporize those high but last ditch team caring patient must vigilant prepared recognize manage complications.5Davidson A.J. Russo R.M. Reva V.A. M.L. L.J. Ball C. pitfalls aorta.J 84: 192-202Crossref (99) Ultrasound skills essential avoid potential problems. Early sheath removal, continuous reassessment ankle-brachial indices, prompt intervention things go wrong crucial save life limb. opinions views expressed commentary authors do necessarily reflect recommendations Journal Vascular Surgery Society Surgery.