Linsenmaier U, Kanz K-G, Rieger J, Krötz M, Mutschler W, Pfeifer K J, Reiser M
Institut für Klinische Radiologie, Klinikum der Universität München, Innenstadt, Ludwig-Maximilians-Universität München.
Rofo. 2003 Sep;175(9):1259-63. doi: 10.1055/s-2003-41931.
To introduce a new interventional method for CT-guided aortic balloon occlusion in patients with life-threatening abdominal or pelvic bleeding.
Three male patients (age 18, 30, and 45 years) with multiple trauma underwent CT-guided balloon occlusion of the aorta after CT identified an active abdominal or pelvic bleeding site and the patients became unstable (systolic blood pressure, BP < 80 mm Hg) despite resuscitation continuous volume. Using a right femoral approach, a 9F sheath was immediately introduced and the positions of the guide wire and balloon catheter (20 x 40 mm) were intermittently checked with CT scans and CT fluoroscopy. In one case, a C-clamp was applied to the pelvic ring under CT guidance for emergency stabilization of an unstable pelvic fracture.
CT-guided aortic balloon occlusion and the mounting of the pelvic C-clamp were technically successful. Intervention time was 4 to 6 minutes for aortic balloon occlusion. All patients became at least temporarily stable hemodynamically with the blood pressure rising above 100 mmHg. The infrarenal occlusion catheters were left in place up to 60 minutes. Suprarenal occlusion was not performed. Two patients died due to protracted shock and complex injuries (injury severity score (ISS: 50 - 64).
CT-guided aortic occlusion provides fast and effective bleeding control immediately after completion of the diagnostic CT. The procedure can be combined with other specific emergency surgical or interventional procedures. Experience with more patients is necessary for further evaluation of this new technique.
介绍一种用于CT引导下对有危及生命的腹部或盆腔出血患者进行主动脉球囊闭塞的新介入方法。
3例男性患者（年龄分别为18岁、30岁和45岁），因多发伤在CT确定腹部或盆腔有活动性出血部位且尽管进行了持续容量复苏患者仍不稳定（收缩压，BP < 80 mmHg）后，接受了CT引导下的主动脉球囊闭塞术。采用右股动脉入路，立即置入9F鞘管，并通过CT扫描和CT透视间歇性检查导丝和球囊导管（20×40 mm）的位置。1例患者在CT引导下对骨盆环应用C形夹，以紧急稳定不稳定的骨盆骨折。
CT引导下的主动脉球囊闭塞及骨盆C形夹的安装在技术上取得成功。主动脉球囊闭塞的介入时间为4至6分钟。所有患者血流动力学至少暂时稳定，血压升至100 mmHg以上。肾下闭塞导管留置长达60分钟。未进行肾上闭塞。2例患者因长期休克和复杂损伤死亡（损伤严重程度评分（ISS）：50 - 64）。
CT引导下的主动脉闭塞在诊断性CT完成后可立即快速有效地控制出血。该操作可与其他特定的急诊手术或介入手术联合使用。需要更多患者的经验来进一步评估这项新技术。
