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Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta

Ogura, Takayuki MD; Lefor, Alan T. MD, MPH; Nakano, Minoru MD, PhD; Izawa, Yoshimitsu MD; Morita, Hideo MD

Journal of Trauma and Acute Care Surgery: January 2015 - Volume 78 - Issue 1 - p 132–135
doi: 10.1097/TA.0000000000000473
Brief Report
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BACKGROUND Many hemodynamically stable patients with blunt abdominal solid organ injuries are successfully managed nonoperatively, while unstable patients often require urgent laparotomy. Recently, therapeutic angioembolization has been used in the treatment of intra-abdominal hemorrhage in hemodynamically unstable patients. We undertook this study to review a series of hemodynamically unstable patients with abdominal solid organ injuries managed nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta.

METHODS The institutional review board approved this study. All patients were appropriately resuscitated with transfusions, and angiography was performed after computed tomography. Resuscitative endovascular balloon occlusion of the aorta was performed before computed tomography in all patients.

RESULTS Seven patients underwent resuscitative endovascular balloon occlusion of the aorta following severe blunt abdominal trauma. The 28-day survival rate was 86% (6 of 7). There were no complications related to the procedure.

CONCLUSION We describe the first clinical series of hemodynamically unstable patients with abdominal solid organ injury treated nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta. Survival rate was 86%, supporting the need for further study of this modality as an adjunct to the nonoperative management of patients with severe traumatic injuries.

LEVEL OF EVIDENCE Therapeutic study, level V.

From the Advanced Medical Emergency Department and Critical Care Center (T.O., M.N.), and Department of Radiology (H.M.), Japan Red Cross Maebashi Hospital, Maebashi, Gunma; and Departments of Surgery (A.T.L.), and Emergency Medicine (Y.I.), Jichi Medical University, Tochigi, Japan.

Submitted: June 11, 2014, Revised: August 14, 2014, Accepted: August 14, 2014.

Address for reprints: Takayuki Ogura, MD, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 371–0014 Asahi-cho 3-21-36, Maebashi, Gunma, Japan; email: alongthelongestway2003@yahoo.co.jp.

© 2015 Lippincott Williams & Wilkins, Inc.