Surgeon at WorkEndovascular Balloon Occlusion of the Inferior Vena Cava in Trauma: A Single-Center Case SeriesHowell, Erin C MD; Kulkarni, Shreyus S MD, MS; Walker, Patrick F MD; Morrison, Jonathan J PhD, FRCS, FACS; Kundi, Rishi MD, FACS; Scalea, Thomas M MD, FACS Author Information From the Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD. Received August 15, 2022; Revised September 5, 2022; Accepted September 6, 2022. Drs Howell and Kulkarni contributed equally to this manuscript. Disclosure Information: Nothing to disclose. Presented at the American Association for the Surgery of Trauma, Chicago, IL, September 2022 Correspondence address: Jonathan J Morrison, PhD, FRCS, FACS, 22 South Greene St, Baltimore, MD 21201. email: [email protected] Journal of the American College of Surgeons 236(2):p e1-e7, February 2023. | DOI: 10.1097/XCS.0000000000000436 Buy Infographic Metrics Abstract Export Injury to the inferior vena cava (IVC) can produce bleeding that is difficult to control. Endovascular balloon occlusion provides rapid vascular control without extensive dissection and may be useful in large venous injuries, especially in the juxtarenal IVC. We describe the procedural steps, technical considerations, and clinical scenarios for using the Bridge occlusion balloon (Philips) in IVC trauma. We present a single-center case series of 5 patients in which endovascular balloon occlusion of the IVC was used for hemorrhage control. All 5 patients were men (median age 35, range 22 to 42 years). They all sustained penetrating injuries—4 gunshot wounds and 1 stab wound. Median presenting Shock Index was 0.7 (range 0.5 to 1.5). Median initial lactate was 5.4 mmol/L (range 4.6 to 6.9 mmol/L). There were 2 suprarenal IVC injuries, 2 juxtarenal injuries, and 3 infrarenal injuries. Four patients underwent primary repair of their injury, and one underwent IVC ligation. Four patients had intraoperative Resuscitative Endovascular Balloon Occlusion of the Aorta for inflow control and afterload support. The median number of total blood products transfused during the initial operation was 37 units (range 16 to 77 units). Four patients underwent damage control operations, and one patient had a single definitive operation. Four of the 5 patients (80%) survived to discharge with the lone mortality being due to other injuries. Endovascular balloon occlusion serves as a valuable adjunct in the management of IVC injury and demonstrates the potential of hybrid open–endovascular operative techniques in abdominal vascular trauma. © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.