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Purpose: Pelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer's acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg. Methods: 60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion. Results: Cumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support. Conclusion: Zone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support. [ABSTRACT FROM AUTHOR]

Background: Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods: Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results: A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions: Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality. [ABSTRACT FROM AUTHOR]

Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise < 30 min, to avoid ischemia/ reperfusion injury, whenever possible. The technique of partial REBOA (P-REBOA) has been developed to minimize the effects of distal ischemia. This study presents our clinical experience with P-REBOA, comparing outcomes to complete occlusion (C-REBOA). Patients and methods: Retrospective analysis of patients' electronic data and local REBOA registry between January 2016 and May 2019. Inclusion criteria: adult trauma patients who received Zone I C-REBOA or P-REBOA for infradiaphragmatic hemorrhage, who underwent attempted exploration in the operating room. Comparison of outcomes based on REBOA technique (P-REBOA vs C-REBOA) and occlusion time (> 30 min, vs ≤ 30 min) Results: 46 patients were included, with 14 treated with P-REBOA. There were no demographic differences between P-REBOA and C-REBOA. Prolonged (> 30 min) REBOA (regardless of type of occlusion) was associated with increased mortality (32% vs 0%, p = 0.044) and organ failure. When comparing prolonged P-REBOA with C-REBOA, there was a trend toward lower ventilator days [19 (11) vs 6 (9); p = 0.483] and dialysis (36.4% vs 16.7%; p = 0.228) with significantly less vasopressor requirement (72.7% vs 33.3%; p = 0.026). Conclusion: P-REBOA can be delivered in a clinical setting, but is not currently associated with improved survival in prolonged occlusion. In survivors, there is a trend toward lower organ support needs, suggesting that the technique might help to mitigate ischemic organ injury. More clinical data are needed to clarify the benefit of partial occlusion REBOA. [ABSTRACT FROM AUTHOR]

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Background: A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs.Methods: Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them.Results: A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001).Conclusions: The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions. [ABSTRACT FROM AUTHOR]

While reading the novella "Chronicle of a Death Foretold" by the Colombian Nobel Laureate Gabriel García-Marquez, we were surprised to realize that the injuries sustained by the main character could have been successfully treated had he received modern trauma care in which REBOA may have been considered. This is a discussion of Mr. Nasar's murder to explore whether he could have been saved by deploying REBOA as a surgical adjunct to bleeding control and resuscitation. In reading García-Marquez's novel we noted the events that unfolded at the time of Santiago Nasar's murder. To contextualize the claim that Mr. Nasar could have survived, had his injuries been treated with REBOA, we explored and illustrated what could have done differently and why. On the day of his death, Mr. Nasar sustained multiple penetrating stab wounds. Although he received multiple stab wounds to his torso, the book describes seven potentially fatal injuries, resulting in hollow viscus, solid viscus, and major vascular injuries. We provided a practical description of the clinical and surgical management algorithm we would have followed in Mr. Nasar's case. This algorithm included the REBOA deployment for hemorrhage control and resuscitation. The use of REBOA as part of the surgical procedures performed could have saved Mr. Nasar's life. Based on our current knowledge about REBOA in trauma surgery, we claim that its use, coupled with appropriate surgical care for hemorrhage control, could have saved Santiago Nasar's life, and thus prevent a death foretold. [ABSTRACT FROM AUTHOR]

Balloon test occlusion (BTO) can predict the ischemic complication risk associated with arterial occlusion. We present a case of an unruptured, broad-necked internal carotid artery-posterior communicating artery (PcomA) aneurysm that was successfully embolized after super-selective BTO of fetal PcomA with electrophysiological monitoring. The proximal portion of the PcomA was internally occluded without causing major neurological deficits, although we observed a small new infarction in the ipsilateral anterior thalamus postoperatively. We recognized small perforators arising from the proximal PcomA during a previous clipping surgery. Super-selective BTO with electrophysiological monitoring could be useful for functional preservation after infarction from angiographically invisible perforators. [ABSTRACT FROM AUTHOR]

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be an adjunct treatment to cardiopulmonary resuscitation (CPR). Aortic occlusion may increase aortic pressure and increase the coronary perfusion pressure and the cerebral blood flow. Peripheral arterial blood pressure is often measured during or after CPR, however, changes in peripheral blood pressure after aortic occlusion is insufficiently described. This study aimed to assess changes in peripheral arterial blood pressure after REBOA in patients with out of hospital cardiac arrest.Methods: A prospective observational study performed at the helicopter emergency medical service in Trondheim (Norway). Eligible patients received REBOA as adjunct treatment to advanced cardiac life support. Peripheral invasive arterial blood pressure and end-tidal CO2 (EtCO2) was measured before and after aortic occlusion. Differences in arterial blood pressures and EtCO2 before and after occlusion was analysed with Wilcoxon Signed Rank test.Results: Five patients were included to the study. The median REBOA procedural time was 11 min and median time from dispatch to aortic occlusion was 50 min. Two patients achieved return of spontaneous circulation. EtCO2 increased significantly 60 s after occlusion, by a mean of 1.16 kPa (p = 0.043). Before occlusion the arterial pressure in the compression phase were 43.2 (range 12-112) mmHg, the mean pressure 18.6 (range 4-27) mmHg and pressure in the relaxation phase 7.8 (range - 7 - 22) mmHg. After aortic occlusion the corresponding pressures were 114.8 (range 23-241) mmHg, 44.6 (range 15-87) mmHg and 14.8 (range 0-29) mmHg. The arterial pressures were significant different in the compression phase and as mean pressure (p = 0.043 and p = 0.043, respectively) and not significant in the relaxation phase (p = 0.223).Conclusion: This study is, to our knowledge, the first to assess the peripheral invasive arterial blood pressure response to aortic occlusion during CPR in the pre-hospital setting. REBOA application during CPR is associated with a significantly increase in peripheral artery pressures. This likely indicates improved central aortic blood pressure and warrants studies with simultaneous peripheral and central blood pressure measurement during aortic occlusion.Trial Registration: The study is registered in ClinicalTrials.gov ( NCT03534011 ). [ABSTRACT FROM AUTHOR]

Resuscitative endovascular balloon occlusion of the aorta (REBOA) for rapid hemorrhage control is increasingly being used in trauma management. Its beneficial hemodynamic effects on unstable patients beyond temporal hemostasis has led to growing interest in its use in other patient populations, such as during cardiac arrest from nontraumatic causes. The ability to insert the catheters without fluoroscopic guidance makes the technique available in the prehospital setting. However, in addition to correct positioning, challenges include reliably achieving aortic occlusion while minimizing the risk of balloon rupture. Without fluoroscopic control, inflation of the balloon relies on estimated aortic diameters and on the disappearing pulse in the contralateral femoral artery. In the case of cardiac arrest or absent palpable pulses, balloon inflation is associated with excess risk of overinflation and adverse events (vessel damage, balloon rupture). In this bench study, we examined how the pressure in the balloon is related to the surrounding blood pressure and the balloon's contact with the vessel wall in two sets of experiments, including a pulsatile circulation model. With this data, we developed a rule of thumb to guide balloon inflation of the ER-REBOA catheter with a simple disposable pressure-reading device (COMPASS). We recommend slowly filling the balloon with saline until the measured balloon pressure is 160 mmHg, or 16 mL of saline have been used. If after 16 mL the balloon pressure is still below 160 mmHg, saline should be added in 1-mL increments, which increases the pressure target about 10 mmHg at each step, until the maximum balloon pressure is reached at 240 mmHg (= 24 mL inflation volume). A balloon pressure greater than 250 mmHg indicates overinflation. With this rule and a disposable pressure-reading device (COMPASS), ER-REBOA balloons can be safely filled in austere environments where fluoroscopy is unavailable. Pressure monitoring of the balloon allows for recognition of unintended deflation or rupture of the balloon. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The goal of this study was to compare the early-to-midterm outcomes of patients treated with the frozen elephant trunk procedure with aortic balloon occlusion (FET-ABO) versus hybrid repair for aortic arch diseases. METHODS Patients who underwent the FET-ABO (n  = 134) and the hybrid procedure (n  = 220) from 2017 to 2020 at our institution were analysed retrospectively. Early-to-midterm outcomes were compared using inverse probability weighting. Low-risk and high-risk subgroup analyses were performed according to the cut-off of the additive European System for Cardiac Operative Evaluation value of 6. RESULTS The present study demonstrated similar 30-day mortality (3.7% vs 8.6%; P  =   0.118) and adverse events between the FET-ABO and the hybrid groups. Fewer intraoperative red blood cell transfusions (0.54 ± 1.45 vs 1.26 ± 2.47 U; P  =   0.001), decreased total hospital costs (P  <   0.001) and considerable early-to-midterm survival [crude: hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.17–0.91; P  =   0.030; adjusted: HR 0.35, 95% CI 0.13–0.91; P  =   0.032) were obtained with the FET-ABO compared to the hybrid procedure. The inverse probability weighting method substantiated the foregoing results. Adjusted subgroup analyses suggested that the FET-ABO procedure had a trend towards improved survival in low-risk patients (HR 0.17, 95% CI 0.03–0.93; P  =   0.041) and achieved outcomes comparable to those of the hybrid procedure in high-risk patients (HR 0.46, 95% CI 0.15–1.42; P  =   0.176). CONCLUSIONS The FET-ABO technique could be better promoted in hospitals lacking experience and equipment and could be more viable and cost-effective for selected patients compared with the hybrid procedure. [ABSTRACT FROM AUTHOR]

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was developed to prevent traumatic exsanguination. We aim to identify the outcomes in animal models with 1) partial versus complete REBOA occlusion and 2) zone 1 versus 2 placements. The PRISMA guidelines were followed. We conducted a search of PubMed, EMBASE and Google Scholar for REBOA studies in animal trauma models using the following search terms: "REBOA trauma", "REBOA outcomes" "REBOA complications". SYRCLE's RoB Tool was utilized for the risk of bias and study quality assessment. Our search yielded 14 RCTs for inclusion. Eleven studies directly investigated partial REBOA versus total aortic occlusion. Overall, partial REBOA techniques were associated with similar attainment of proximal MAP but with significantly less ischemic burden. Significant mortality benefit with partial occlusion was observed in three studies. Survival time post-occlusion also was improved with zone 3 placement versus zone 1 (100% versus 33%; P < 0.01). There appears to be a fine balance between desired proximal arterial pressure and time of occlusion for overall survival and subsequent risk of distal ischemia. Many "partial occlusion" techniques may be superior in attaining such balance over prolonged REBOA inflation where no distal flow is allowed. Tailored zone 3 placement may offer significant mortality and morbidity advantages compared to sustained total occlusion and indiscriminate zone 1 placement strategies. As clear conclusions regarding REBOA are unlikely to be established in animal models, larger randomized investigations utilizing human subjects are needed to describe optimal REBOA technique and applicability in greater detail. [ABSTRACT FROM AUTHOR]

Introduction: This study examined national-level trends, characteristics, and perioperative outcomes of women who had intra-arterial balloon occlusion at cesarean hysterectomy for placenta accreta spectrum (PAS).Material and Methods: This was a population-based retrospective observational study that queried the National Inpatient Sample from October 2015 to December 2018. Study population was women who underwent hysterectomy at cesarean delivery for PAS (n = 6440 in 806 centers). Exposure allocation was the use of intra-arterial balloon occlusion. Main outcome measures were (a) characteristics associated with intra-arterial balloon occlusion use, and (b) perioperative outcome including hemorrhage, blood transfusion, coagulopathy, shock, urinary tract injury, intra-arterial balloon occlusion-related complication (arterial injury, arterial thrombosis, and lower extremities ischemia), and death, assessed in multivariable analysis.Results: Intra-arterial balloon occlusion was used in 420 (6.5%) women in 64 (7.9%) centers. Utilization of intra-arterial balloon occlusion during cesarean hysterectomy for placenta accreta decreased significantly over time (from 6.3% to 3.1%, p < 0.001), but not in placenta increta (from 12.8% to 9.3%, p = 0.204) or placenta percreta (from 21.3% to 17.5%, p = 0.344). In a multivariable analysis, patient factors (younger age, earlier year, obesity, diabetes mellitus), pregnancy factors (placenta increta/percreta, previous cesarean delivery, placenta previa, and early gestational age), and facility factors (large bed capacity, urban teaching status, and Northeast/West regions) represented the independent characteristics for using the intra-arterial balloon occlusion (all, p < 0.05). In a classification-tree model, the absolute difference in intra-arterial balloon occlusion use among 18 utilization patterns was 48% (range, 0%-48%). In perioperative outcome analysis, women who received intra-arterial balloon occlusion were more likely to have coagulopathy (adjusted odds ratio [aOR] 3.43) and arterial thrombosis (aOR 9.82) in placenta accreta, but less likely to have hemorrhage (aOR 0.25) in placenta increta, and blood transfusion (aOR 0.60) and urinary tract injury (aOR 0.28) in placenta percreta compared with those who did not (all, p < 0.05).Conclusions: There is a wide range in the utilization of intra-arterial balloon occlusion at cesarean hysterectomy for PAS based on patient, pregnancy, and facility factors, which implies that there is a lack of universal practice guidelines in this surgical procedure. Whether the use of intra-arterial balloon occlusion in the severe forms of PAS improves surgical outcome merits further investigation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the association of REBOA and mortality in a group of patients with penetrating trauma to the torso, treated in a level-I trauma center from Colombia. Methods: In a retrospective cohort study, patients with penetrating trauma, requiring emergency surgery, and treated between 2014 and 2018, were included. The decision to use or not use REBOA during emergent surgery was based on individual surgeon's opinion. A propensity score (PS) was calculated after adjusting for age, clinical signs on admission (systolic blood pressure, cardiac rate, Glasgow coma scale), severe trauma in thorax and abdomen, and the presence of non-compressive torso hemorrhage. Subsequently, logistic regression for mortality was adjusted for the number of red blood cells (RBC) transfused within the first six hours after admission, injury severity score (ISS), and quintiles of PS. Results: We included 345 patients; 28 of them (8.1%) were treated with REBOA. Crude mortality rates were 17.9% (5 patients) in REBOA group and 15.3% (48 patients) in control group (p = 0.7). After controlling for RBC transfused, ISS, and the PS, the odds of death in REBOA group was 78% lower than that in the control group (odds ratio [OR] 0.20, 95% confidence interval [95%CI] 0.05–0.77, p = 0.01). Conclusion: We found that, when compared to no REBOA use, patients treated with REBOA had lower risk-adjusted odds of mortality. These findings should be interpreted with caution and confirmed in future comparative studies, if possible. [ABSTRACT FROM AUTHOR]

Purpose: Non-compressible torso hemorrhage is a major but potentially preventable cause of trauma-related mortality. REBOA has rapidly emerged as an adjunct for hemorrhage control. However, little is known about the proportion of trauma patients in which REBOA may be indicated. The aim of our study was to determine this proportion. Methods: A retrospective cohort study of all adult (≥ 16 years) trauma patients treated at our facility (a university hospital and trauma referral center covering 2.5 million inhabitants) between 2012 and 2017 was performed. Potential candidates for REBOA were patients with an abdominal and/or pelvic injury and an Abbreviated Injury Scale (AIS) score of ≥ 3, who arrived in shock (defined as a systolic blood pressure, SBP ≤ 90 mmHg). Patients with potential contraindication for REBOA (prehospital cardiac arrest or thoracic vascular injury) were excluded. Results: From a total of 7229 patients during the study years, 31 (0.4%) patients met the criteria for potential use of REBOA. In this cohort, the total mortality was 45% and the mortality within 30 days was 26%. The mean Injury Severity Score (ISS) was 46.3 and mean SBP was 72 mmHg. Conclusions: The study suggests a potential indication for REBOA (incidence) of 2.5 per one million inhabitants per year according to the used criteria. Local REBOA guidelines may vary but a significant number of trauma centers use similar criteria. Although the total mortality within this group is high, the number of patients that theoretically may benefit from the use of REBOA is low. [ABSTRACT FROM AUTHOR]

Patients with placenta previa are at risk for intra- and postpartum massive blood loss as well as increased risk of placenta accreta, a type of abnormal placental implantation. This condition can lead to serious obstetric complications, including maternal mortality and morbidity. The risk factors for previa include prior cesarean section, multiparity, advanced maternal age, prior placenta previa history, prior uterine surgery, and smoking. The prevalence of previa parturients has increased due to the rising rates of cesarean section and advanced maternal age. For these reasons, we need to identify the risk factors for previa and identify adequate management strategies to respond to blood loss during surgery. This review evaluated the diagnosis of placenta previa and placenta accreta and assessed the risk factors for previa-associated bleeding prior to cesarean section. We then presented intraoperative anesthetic management and other interventions to control bleeding in patients with previa expected to experience massive hemorrhage and require transfusion.

Abstract Objective Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less‐invasive method for temporary hemostasis compared with cross‐clamping the aorta through resuscitative thoracotomy (RT). Although the survival benefits of REBOA remained unclear, pathophysiological benefits were identified in patients with traumatic out‐of‐hospital cardiac arrest (t‐OHCA). We examined the clinical outcomes of t‐OHCA with the hypothesis that REBOA would be associated with higher survival to discharge compared with RT. Methods A retrospective cohort study was conducted using the Japan Trauma Data Bank (2004–2019). Adult patients with t‐OHCA who had arrived without a palpable pulse and undergone aortic occlusion were included. Patients were divided into REBOA or RT groups, and propensity scores were developed using age, mechanism of injury, presence of signs of life, presence of severe head and/or chest injury, Injury Severity Score, and transportation time. Inverse probability weighting by propensity scores was performed to compare survival to discharge between the 2 groups. Results Among 13,247 patients with t‐OHCA, 1483 were included in this study. A total of 144 (9.7%) patients were treated with REBOA, and 5 of 144 (3.5%) in the REBOA group and 10 of 1339 (0.7%) in the RT group survived to discharge. The use of REBOA was significantly associated with increased survival to discharge (odds ratio, 4.78; 95% confidence interval, 1.61–14.19), which was confirmed by inverse probability weighting (adjusted odds ratio, 3.73; 95% confidence interval, 1.90–7.32). Conclusions REBOA for t‐OHCA was associated with higher survival to discharge. These results should be validated by further research.

Background Morbidly adherent placenta (MAP) may cause life-threatening postpartum hemorrhage (PPH) requiring massive transfusions. Furthermore, it could endanger the lives of both mother and baby. Despite various efforts, such as adjuvant endovascular embolization and hysterectomy, massive PPH due to MAP still occurs and is difficult to overcome. Case Herein, we described the case of a 40-year-old woman with placenta previa totalis who experienced massive bleeding during a cesarean section. We used resuscitative endovascular balloon occlusion of the aorta (REBOA) and it improved the condition of the surgical field and the hemodynamic stability of the patient temporarily. The patient was successfully managed without further complications. Conclusions REBOA can be used as a rescue procedure for uncontrolled bleeding situations in patients with MAPs. Anesthesiologists should consider and recommend REBOA as another resuscitative therapeutic option in the case of massive PPH.

Aim. Analysis of operative delivery outcomes in pregnant women with abnormal invasive placenta depending on the endovascular treatment for intraoperative haemostasis.Materials and methods. A retrospective study of operative delivery outcomes was performed in 178 patients with placental invasion using ultrasonography (US) data obtained at the Perinatal Centre of the Regional Clinic Hospital No. 2, Ministry of Health of Krasnodar Krai, in the years 2012–2018. In 2012–2014, delivery was managed without endovascular haemostasis (n = 44), and from May 2014 to December 2018 – with prophylactic balloon catheterization of common iliac arteries (n = 134). Upon intraoperative diagnosis of placental invasion, temporary balloon occlusion (TBO, n = 115) and/or uterine artery embolization (UAE, n = 33) were performed. Efficiency of endovascular methods for intraoperative haemostasis was assessed by comparing the degree of placental invasion, amount of blood loss and transfusion, frequency of hysterectomies (HE), duration of surgery, length of stay in intensive care units (ICU) and outcomes for the foetus.Results. Adoption of endovascular methods for intraoperative haemostasis allowed the blood loss (p = 0.02), haemotransfusion (p = 0.012) and HE frequency (p

Aim: It is difficult to treat delayed acetabular fractures due to massive blood loss during operation. Temporary balloon occlusion of the abdominal aorta was introduced into sacral tumor surgery to reduce intraoperative hemorrhage. The aim of this study was to investigate the effect of this method on reduction of intraoperative blood loss and analyze the complications of this technique in the treatment of delayed acetabular fracture. Methods: We retrospectively reviewed 43 patients with delayed acetabular fracture who were surgically treated through combined approaches. Nineteen patients underwent temporary balloon occlusion of the abdominal aorta; 10 patients had type B fracture and 9 patients had type C fracture according to the Müller AO classification. The remaining 24 patients were classified into a control group; 14 patients had type B fracture and 10 patients had type C fracture. Surgical time, intraoperative blood loss, blood transfusion, satisfactory reduction rate, and functional recovery were recorded and compared between two groups. Merle d'Aubigné and Postel scoring was applied to evaluate the patients. Results: The patients treated with intra-aortic balloon occlusion had a shorter surgical time (p = 0.008), less intraoperative blood loss (p = 0.005), and less transfused blood units (p = 0.001). No complications caused by balloon occlusion. No significant difference were observed in the outcomes and the complications related to acetabular fractures between two groups. Conclusions: Temporary balloon occlusion of the abdominal aorta is a reliable technique to control bleeding for the surgery of delayed acetabular fracture.

Super-selective lipiodol balloon-occluded transarterial chemoembolization (SSLB-TACE) increases lipiodol accumulation in the targeted nodule. To understand the mechanism of increased accumulation, it is necessary to understand intra-hepatic collateral system and rheology of lipiodol. Although SSLB-TACE is thought to be a promising technique, randomized prospective controlled trials to compare local control rates with conventional super-selective lipiodol (c-TACE) are still lacking. Another problem for SSLB-TACE is change of TACE candidates by development of radiofrequency ablation (RFA) technology. Patients with limited number of small nodules are good candidates for both SSLB-TACE and c-TACE, but these are also good candidates for RFA. Because higher priority is given to RFA, TACE is usually indicated for patients with 4 or more nodules, with large nodule(s), and/or with proximal Glisson attaching nodule(s). However, these cases are known as TACE-refractory, and the chance to perform SSLBTACE or c-TACE would be markedly decreased in institutions where RFA is aggressively performed. In the past, paradigm shift from non-selective TACE to super-selective TACE occurred, and the goal of SSLB-TACE and c-TACE is prolonged complete remission of the treated nodules while sacrificing small volume of liver parenchyma. But another TACE technique, aiming treatment of wide region (hemi-lobe or more) and effective tumor volume reduction while minimizing liver parenchymal damage, is mandatory in RFA era. For this purpose, we developed a new balloon-occluded TACE without using lipiodol; alternate infusion of cisplatin solution and sparse gelatin slurry was repeated under balloon-occlusion (RAIB-TACE) until stasis of gelatin slurry in proximal hepatic arteries was seen. However, not only RFA but also recent development of molecular targeted drugs strongly influences on the indication and the aim of TACE. The goal and technique of TACE should be properly selected in each era, in each institution, and for each patient.

Background Cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts involving the dura mater, located within or near the walls of the CS. Transvenous embolization is considered to be an effective treatment for CS DAVF. We describe a novel technique for the use of transvenous Onyx embolization in the treatment of CS DAVF, which uses a temporary balloon to occlude the arterial side for flow control. Case Report A 63-year-old woman presented with ocular pain and ptosis of the left eye. Cerebral angiography showed a left CS DAVF fed by multiple branches of the left external carotid artery. We successfully treated the CS DAVF using transvenous Onyx embolization with temporary balloon occlusion of the proximal feeding artery to decrease the shunted flow. Conclusion Transvenous Onyx embolization with flow control via temporary balloon occlusion may be a useful technique for the embolization of CS DAVFs with multiple arterial feeders.

Objective : We assessed the available literature regarding patients undergoing minimally invasive mitral valve surgery (MIMVS) with either transthoracic clamping (TTC) or endoaortic balloon occlusion (EABO). Methods : Original research studies that evaluated the perioperative outcomes of TTC versus EABO group were identified from 2000 to 2024. The incidence of all-cause mortality, cerebrovascular accidents (CVA), and aortic dissections were the primary endpoints. The cardiopulmonary bypass (CPB), cross-clamp, and ventilation time, along with the incidence of conversion to sternotomy, re-exploration, new-onset atrial fibrillation (AF), postoperative acute kidney injury (AKI), ICU stay, and LOS were the secondary endpoints. Subgroup analyses were performed regarding the EABO cannulation approach (femoral and aortic) and MIMVS approach (video-assisted and robotic-assisted). Sensitivity analyses were performed with the leave-one-out method and by including risk-adjusted populations. Results : Sixteen studies were included in both the qualitative and quantitative syntheses. After pooling data from 6335 patients, both groups demonstrated similar outcomes on all primary and secondary endpoints in the non-adjusted and adjusted total cohort analyses. These outcomes were further validated by the leave-one-out sensitivity analysis. In addition, the aortic cannulation EABO was associated with a lower cross-clamp time, followed by TTC and the femoral cannulation EABO approach. Furthermore, in the video-assisted subgroup analysis, the EABO approach was associated with a higher incidence of CVA, conversion to sternotomy, and longer ICU stay compared to the TTC group. Conclusions : The present meta-analysis indicates that both aortic occlusion techniques are safe and feasible in the context of MIMVS. A future well-designed randomized-control trial should further validate the current outcomes.

Pulmonary artery rupture is a rare complication of right heart catheterization characterized by a rapid clinical deterioration and high mortality rate. We present the case of an 89-year-old woman with severe symptomatic aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement. The patient had acute cardiopulmonary deterioration due to pulmonary artery rupture at the time of right heart catheterization, that was successfully sealed by balloon tamponade., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Conventional vascular interventions and hybrid surgery relied on digital subtraction angiography (DSA). Previously our center explored hybrid partial nephrectomy with DSA guidance, which demonstrates the superiority of omitting the dissection of renal hilum. However, this approach is limited to scarce hybrid operating rooms, involves radiation exposure, and poses compatibility issues with robotic surgery platforms. Laparoscopic ultrasound (LUS) can assist in robotic surgery. This study explored the application of LUS-guided occlusion of renal artery blood supply with a Fogarty balloon catheter, particularly in hybrid partial nephrectomy for renal tumor treatment., Case Description: The LUS-guided renal artery balloon catheter occluded hybrid partial nephrectomy (UBo-HPN) involved several steps: trans-femoral artery cannulation, placement of the balloon catheter into the renal artery via the femoral vascular sheath, occlusion of the renal blood supply by inflating the balloon catheter, completion of zero-ischemia partial nephrectomy with arterial flow occluded, withdrawal of the balloon catheter after deflation. For all three patients, the balloon catheter was successfully and accurately placed into the selected renal artery under LUS guidance. Intraoperative occlusion of the renal blood supply was confirmed to be complete and reversible. No complications were observed during follow-up., Conclusions: LUS guidance presents a safe alternative to DSA guidance for assisting in hybrid surgery. LUS-guided hybrid partial nephrectomy is safe and feasible., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-24-22/coif). The authors have no conflicts of interest to declare., (2024 Translational Andrology and Urology. All rights reserved.)

Objective: To evaluate the application of different uterine artery embolization procedures under balloon occlusion of the abdominal aorta in patients with Placenta Accreta Spectrum (PAS) undergoing cesarean section., Materials and Methods: A retrospective analysis was performed on clinical data from 72 patients who underwent uterine artery embolization for hemostasis during cesarean section with PAS. The patients were divided into two groups according to the embolization method used during surgery: group A (n = 43) underwent uterine artery embolization by withdrawing the balloon and inserting a Cobra catheter into the uterine artery for embolization, while group B (n = 29) underwent uterine artery embolization with a Cobra catheter inserted via contralateral puncture of the femoral artery and balloon occlusion. General information, surgical data, and postoperative recovery were compared between the 2 groups., Results: The bleeding and transfusion volumes were lower in group B than in group A and the differences between the 2 groups were statistically significant. There were no significant differences in surgical duration, number of embolized vessels, length of hospital stay, postoperative complications, or menstrual recovery between the 2 groups., Conclusion: For patients with PAS undergoing cesarean section, uterine artery embolization for hemostasis is preferably performed by inserting a Cobra catheter via contralateral puncture of the femoral artery under abdominal aortic balloon occlusion.

Purpose: Treatment of hypovascular tumors, such as pancreatic adenocarcinoma, is challenging owing to inefficient drug delivery. This report examines the potential mechanism of localized drug delivery via transarterial microperfusion (TAMP) using a proprietary adjustable double-balloon occlusion catheter in a porcine model., Materials and Methods: Adult Yorkshire swine (N = 21) were used in the Institutional Animal Care & Use Committee-approved protocols. The RC-120 catheter (RenovoRx, Los Altos, California) was positioned into visceral, femoral, and pulmonary arteries with infusion of methylene blue dye, gemcitabine, or gold nanoparticles. Transmural delivery was compared under double-balloon occlusion with and without side-branch exclusion, single-balloon occlusion, and intravenous delivery. Intra-arterial pressure and vascular histologic changes were assessed., Results: Infusion with double-balloon occlusion and side-branch exclusion provided increased intra-arterial pressure in the isolated segment and enhanced perivascular infusate penetration with minimal vascular injury. Infusates were predominantly found in the vasa vasorum by electron microscopy., Conclusions: TAMP enhanced transmural passage mediated by localized increase in arterial pressure via vasa vasorum., (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)

Uterine arteriovenous malformations (AVMs) are rare conditions that cause life-threatening bleeding. Endovascular treatment or total hysterectomy is performed to safely treat most AVMs. This case report describes a 54-year-old female patient with a large uterine AVM, uterine bleeding, and cardiac overload that was difficult to manage but successfully treated. Total hysterectomy poses a high risk of hemorrhage due to significant uterine and internal iliac vein dilation; thus, embolization of feeding arteries was performed with N-butyl cyanoacrylate. However, a postembolization computed tomography scan detected paradoxical embolization of the liver, kidneys, and spleen. Therefore, supracervical hysterectomy was performed with preoperative coil embolization and intraoperative balloon occlusion of the feeding arteries. In this case, supracervical, not total, hysterectomy needed to be performed as the shunts were determined to be in the uterine corpus., (© 2024 The Authors. Published by Elsevier B.V.)

Stab wounds, particularly those affecting multiple body regions, present considerable challenges in trauma care. This report describes a case of sustained self-inflicted stab injuries to the abdomen and thighs of a 23-year-old male patient. Although the patient's vital signs were stable and bleeding was minimal from thigh wounds without overt signs of vascular injury, the patient experienced a sudden, profound hemorrhage from the right thigh, leading to cardiac arrest. Successful resuscitation was followed by surgical repair of a right superficial femoral arterial injury accompanying a resuscitative endovascular balloon of the aorta. Subsequent lower extremity computed tomography angiography revealed no additional vascular abnormalities. The patient was discharged in stable condition on the 12th postoperative day. This case underscores the unpredictability of stab wound trajectories and the potential for hidden vascular injuries, even in the absence of immediate life-threatening signs. It also emphasizes the critical role of advanced imaging modalities, such as computed tomography angiography, in identifying concealed injuries, and the importance of strategic intraoperative techniques, including resuscitative endovascular balloon occlusion of the aorta, in achieving favorable patient outcomes., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (© 2024 The Korean Society of Traumatology.)

The article discusses the importance of timely interventions in medical emergencies, such as acute myocardial infarction, ischaemic stroke, and trauma-related haemorrhage. The UK-REBOA and CRYOSTAT-2 trials, which evaluated interventions for haemorrhagic shock, faced challenges related to delays in treatment delivery. The studies found that the timing of interventions significantly impacted patient outcomes. The article highlights the need for prompt and efficient care in order to improve survival rates in these critical situations. [Extracted from the article]

This article, published in the European Heart Journal Case Reports, describes a case of a 77-year-old man with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) with the use of embolic protection devices (EPDs) to prevent cerebral infarction. The patient had a mobile mass on the aortic valve and an occlusion of the right internal carotid artery, indicating a high risk for intra-operative cerebral infarction. The EPDs, including filters and an occlusion balloon catheter, were successfully deployed during the TAVR procedure, and post-operative imaging showed minor ischaemic lesions but no symptoms of cerebral infarction. The article highlights the safety and efficacy of using EPDs in TAVR procedures, particularly for patients with a history of cerebrovascular events or chronic kidney disease. [Extracted from the article]

A mechanical theory is described for a phenomenon in the surgical procedure of resuscitative endovascular balloon occlusion of the aorta (REBOA). In this procedure a balloon is pushed into the aorta by a catheter and then inflated in order to stop haemorrhage. One of the hazards of this procedure is the tendency for the balloon to migrate away from its intended position. This work examines the mechanics of balloon anchoring and migration by analysing the effects of pressure waves, the sheet flow and solid friction in the thin gap between the walls of the aorta and balloon. A viscoelastic model is adopted for the aorta wall for pressure waves between the left ventricle and the balloon. The lubrication approximation is used for blood flow in the thin gap between the walls of the balloon and aorta. Samples of quantitative predictions are discussed on how the inflation pressure and balloon characteristics affect the balloon anchoring and migration. The crucial roles of solid friction and balloon placement are pointed out, which should help in guiding the manufacturing of balloons and their usage in the field. [ABSTRACT FROM AUTHOR]

Background: Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation: A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion: This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report. [ABSTRACT FROM AUTHOR]

Time is the enemy: mortality in trauma patients with hemorrhage from torso injury occurs long before the "golden hour". In our opinion, this study also highlights that, moving forward, there is a need to include all trauma patients in national registries and establish why injured patients die in the early post-injury phase. Keywords: emergency medical services; pre-hospital care; trauma EN emergency medical services pre-hospital care trauma 1450 1453 4 10/05/21 20211101 NES 211101 The optimal delivery of pre-hospital care is much debated, especially with regard to the role of helicopters and the use of critical care interventions such as anaesthesia and ventilation. This is important because it is evident that the peak death rate following injury occurs rapidly, within 30 min of injury, well before the majority of injured patients can reach hospital [9]. [Extracted from the article]

Purpose: This animal experimental study evaluated how hepatic artery and portal vein transient occlusion affects the ablation zone of hepatic radiofrequency ablation (RFA).Material and Methods: Twenty-one rabbits were divided into three groups of seven each: (1) control, (2) hepatic artery occlusion, and (3) portal vein occlusion by a balloon catheter. For each rabbit, two or three RFA sessions were performed using an electrode needle. Ablation time, temperature around the tip of RFA needle at the end of RFA, ablation volume on fat-suppressed T1-weighted image in the hepatobiliary phase, and coagulative necrosis area on histopathology were measured and compared between the three groups using the Kruskal-Wallis paired Mann-Whitney U tests.Results: In 43 RFA sessions (group 1, 15; group 2, 14; group 3, 14), mean tissue temperature in group 3 (77.0 °C ± 7.7 °C) was significantly higher compared to groups 1 (59.2 °C ± 18.8 °C; P = 0.010) and 2 (67.5 °C ± 9.9 °C; P = 0.010). In addition, mean ablation volume and coagulative necrosis in group 3 (2.10 ± 1.37 mm3 and 0.86 ± 0.28 mm2, respectively) were larger compared to groups 1 (0.84 ± 0.30 mm3; P < 0.001 and 0.55 ± 0.26 mm2; P = 0.020, respectively) and 2 (0.89 ± 0.59 mm3; P = 0.002 and 0.60 ± 0.22 mm2; P = 0.024, respectively).Conclusion: Portal vein occlusion potentially boosts tissue temperature, ablation volume, and area of histopathologically proven coagulative necrosis during hepatic RFA in the non-cirrhotic liver. [ABSTRACT FROM AUTHOR]

Background: The percutaneous transcatheter closure of patent ductus arteriosus (PDA) has been a widely used treatment method. However, PDA device closure in neonates or patients with specific PDA morphology has been difficult due to the protrusion of the device into the descending aorta. The right angle between the disc and plug causes some degree of protrusion of the disc into the descending aorta because normal PDA forms an acute angle with the descending aorta. Objectives: There have been limited data about the angles of PDA since Mancini's study in 1951, and new studies are required in this regard. This study measured the angles between PDA and descending aorta through angiography in a beating heart. Methods: Within December 2008 to November 2016, 190 patients undergoing percutaneous PDA occlusion were included in this study. Retrospectively, the mean angle of PDA was measured by three cardiologists between the longitudinal axis of the descending aorta and the longitudinal axis of the PDA through an aortogram. The patients were divided into three groups according to age (group A: under 1, group B: 1-6, and group C: over 6 years of age) and PDA morphology based on Krichenko's classification (type A: conical PDA, type B: window PDA, type C: tubular PDA, type D: complex PDA, and type E: elongated PDA). Results: Of 190 study patients, 135 patients were female, and the median age of the patients was 7 years (range: 75 days to 60 years). The mean angle of PDA was 48.2±12.0°. There were no statistical differences regarding PDA angle among the groups classified by age and PDA morphology. [ABSTRACT FROM AUTHOR]

To assess the efficacy and safety of abdominal aortic (AA) balloon occlusion versus internal iliac arteries (IIA) balloon occlusion in patients with placenta accreta spectrum (PAS) disorders. Databases of Embase, PubMed, Web of Science and Cochrane Library were systematically searched from inception to May 2020. The relevant literature was screened and the quality was assessed. RevMan software 5.3 was used to analyze the data. Six studies involving 239 patients in AA occlusion and 281 patients in IIA occlusion were included. The results demonstrated that the intraoperative hemorrhage volume (MD − 410.61 ml, 95% CI -779.74 to −41.47 ml, p < 0.001), balloon dilatation duration (MD -5.34 min, 95% CI -9.91 to −0.77 min, p = 0.02) and fetus radiation dose (MD-20.81 mGy, 95% CI -31.84 to −9.78 mGy, p < 0.001) were significantly less in AA occlusion compared to IIA occlusion. There was no significant difference in the rate of lower extremity thrombosis between AA occlusion and IIA occlusion (OR 0.21, 95% CI 0.02 to 2.21, p = 0.19); similarly, no significant differences were found in blood transfusion volume (MD −344.50 ml, 95% CI -735.74 to 46.74 ml, p = 0.08), the rate of hysterectomy (OR 0.99, 95% CI 0.22 to 4.44, p = 0.99) and other outcome variables. The available data demonstrated AA occlusion was more effective in reducing intraoperative hemorrhage volume and fetus radiation dose compared with IIA occlusion in patients with PAS disorders. Larger studies or randomized controlled trials are needed to further assert this evidence. • Endovascular intervention in abnormal placentation deliveries is effective in reducing blood loss. • Endovascular intervention did not result in longer operative time or hospital stay. • Prophylactic balloon occlusion of the abdominal aorta is superior to other modalities. [ABSTRACT FROM AUTHOR]

Objective: Puig types 2 through 4 venous malformations (VMs) are challenging to treat with sclerotherapy given their robust systemic outflow. Endovenous balloon occlusion offers a means of temporarily occluding systemic venous outflow to allow for more complete sclerotherapy. This study reviews our experience of implementing this technique in patients with Puig advanced (types 2 through 4) VMs. Methods: An IRB approved review of treated venous malformations from 2013–2016 revealed 10 patients fitting inclusion criteria. Patient demographics, pre-procedural imaging, intra-procedural technical parameters, and post-procedural follow-up outcomes were recorded. All patients underwent temporary balloon occlusion of a systemic or major draining vein during sclerotherapy. Embolic agents included n-butyl cyanoacrylate glue, sodium tetradecyl sulfate foam, and coils. Standard 5 French angioplasty balloons ranged from 4 to 8 mm diameter and 2 to 8 cm length depending on vessel requiring occlusion. All patients underwent minimum 3-year follow-up questionnaire administration re-assessing resolution of lesion symptomology and post-procedural quality of life (QoL) measures. Results: Of the 10 VMs treated, 2 were Type 2, 6 were Type 3, and 2 were Type 4. More than one sclerotherapy session was required in 7/10 patients (mean: 2, range: 1–4). Most common sites of VM systemic drainage included subclavian, popliteal, internal/external jugular, and basilic veins. All patients had no indication for further sclerotherapy following adjunctive balloon occlusion. No non-target embolization or immediate post-procedural complications occurred. Follow-up questionnaires (mean interval: 3 years 6 months, range: 3 years–3 years 11 months) confirmed the persistence of embolization effects, improved QoL, and no additional sclerotherapy sessions for all patients in the cohort. Conclusions: Endovenous balloon occlusion as an adjunct to sclerotherapy can be considered when treating patients with types 2–4 venous malformations. This technique lowers the risk of non-target systemic venous embolization, allowing for operator-driven deeper intralesional sclerosant penetration and subsequently maintained treatment efficacy. [ABSTRACT FROM AUTHOR]

Purpose: Abnormally invasive placenta is an important cause of maternal morbidity, and its primary complication is massive bleeding. Strategies for preventing bleeding include arterial endovascular occlusion. One concern with the use of intra-arterial occlusion balloons is radiation exposure to the fetus, which occurs while determining balloon position. In this study, we sought to determine the radiation absorbed dose by the fetus during intra-aortic occlusion balloon placement in patients with abnormally invasive placenta.Materials and Methods: We estimated the fetal absorbed dose and the entrance skin dose in the vaginal fundus and lumbar skin, respectively, using thermoluminescent dosimeter crystals, during intra-aortic balloon positioning using the mobile X-ray image intensifier system (C-arm) in digital radiography mode, directly in surgery room, without transfer to angiographic suite. We also performed a mannequin-based simulation to validate the entrance skin dose measurement technique.Results: Ten women undergoing surgical management of an abnormally invasive placenta, in whom the location of the intra-aortic occlusion balloon was verified using plain radiography with C-arm in the surgery room, were included in the study. Following maternal and fetal radiation exposure, the entrance skin dose and radiation absorbed dose by the fetus were 1.31 ± 0.96 mGy and 0.27 ± 0.28 mGy, respectively, with radiation exposure durations of <1 s.Conclusions: There were no complications with the use of REBOA, the radiation absorbed dose by the fetus, entrance skin dose, and duration of radiation exposure during intra-aortic occlusion balloon placement were lower than those reported for other vascular occlusion techniques, being this a safe procedure. [ABSTRACT FROM AUTHOR]

Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study.Methods: This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of ABO group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during in-hospital stay were also recorded.Results: The 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO reduced postoperative acute kidney injury (23.1% vs. 35.7%, P = 0.013) and hepatic injury (12.3% vs. 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs. 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge.Conclusions: The ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay. [ABSTRACT FROM AUTHOR]

While blunt trauma was the most common mechanism of injury among all patients, PD patients were found to have higher rates of penetrating injury than non-PD patients (17.9% v. 8.6%, p < 0.001) and were more commonly victims of assault (5.3% v. 2.1%, p < 0.001). To identify optimal practices for the care of these patients in our inclusive, provincial trauma system, we sought to determine if there were important differences in patient composition or outcomes among adult patients with isolated subdural hematomas admitted to a neurosurgical trauma centre (NSTC) versus those admitted to a level 3, non-neurosurgical trauma centre (non-NSTC). Embolization in nonsplenic trauma: outcomes at a Canadian trauma hospital Background Angiography and embolization for hemorrhage control is first-line treatment for solid organ and pelvic injuries in hemodynamically stable trauma patients. Blunt injuries were most common (144 patients [81.8%] had a blunt injury, 27 [15.3%] had a penetrating injury and 3 [1.7%] had a burn), with average Injury Severity Score 13 (1-45) and average length of stay 10.6 (SD 14.6) days. Motor vehicle crashes (MVCs) predominated (66 patients, 37.5%) followed by falls (33 patients, 18.8%), sport-related injuries (30 patients, 17.1%) and stabbings (17 patients, 9.7%). [Extracted from the article]

Introduction: To evaluate the efficacy, safety, and associated complications of a novel and simple approach to portal vein embolization that utilizes sheath injection and balloon occlusion (PVE-SIBO) with gelatin sponge (GS) for the purpose of increasing future liver remnant (FLR) volume. Methods: Between 1 January, 2006, and 31 August, 2020, 20 patients (15 men, 5 women, aged 64.6 ± 10.2 years) diagnosed with hepatobiliary malignancy underwent presurgical PVE-SIBO at our institution via a percutaneous transhepatic approach to the right portal vein and embolization of the portal vein with GS. We evaluated the increased ratio of FLR volume, operation duration, recanalization rate, and complications following this procedure. Results: All procedures were successful and without complications such as subcapsular hematoma, intra-abdominal bleeding, and bile leakage. The increased ratio of FLR volume was 34.7 ± 23.7% after a mean of 14.3 ± 2.57 days, and there was a significant difference in the FLR volume before and after PVE (P < 0.01). Procedure time was 52.7 ± 11.4 minutes. Conclusion: PVE-SIBO with GS is a simple, effective, and safe procedure to increase the ratio of FLR volume prior to hepatic surgeries.

Abstract Resuscitative endovascular balloon occlusion of the aorta is useful as a troubleshooting response to hemorrhage and a temporary method for maintaining patient hemodynamics.