1 Michael G. Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
2 Divisions of General Surgery and Critical Care, McMaster University, Hamilton, Ontario, Canada.
J Endovasc Ther. 2018 Apr;25(2):257-260. doi: 10.1177/1526602818757012. Epub 2018 Feb 6.
To report unconventional use of the resuscitative endovascular balloon occlusion of the aorta (REBOA) technique to restore hemodynamic stability in a patient who was hemorrhaging from aortic injury proximal to the target zone of occlusion.
A 72-year-old woman underwent urgent thoracic stent-graft repair of a ruptured 8×8-cm mycotic pseudoaneurysm. Two months later, follow-up imaging revealed that the proximal aortic stent seal zone had degenerated, so a percutaneous procedure was performed 2 months later to preemptively reinforce the segment of stented aorta. Shortly after obtaining femoral access, the patient's condition abruptly deteriorated with profound hypotension, presumably a result of an access complication. REBOA was established in the supraceliac aorta, which sustained the mean arterial pressure while the anesthesiologist resuscitated the patient. Unexpectedly, angiography showed a rupture of the descending thoracic aorta immediately proximal to the upper stent-graft. Balloon inflation distal to the rupture site was maintained while the patient's hypotension was treated. Another stent-graft was quickly placed over the area of concern, overlapping proximal to the prior grafts. Once the aortic perforation was sealed, the patient stabilized hemodynamically. Inotropic support was weaned, and the REBOA occlusion catheter was deflated. Final angiograms of the arch and thoracic aorta confirmed no extravasation; angiograms of the infrarenal aorta and iliac arteries showed no evidence of injury.
This case illustrates that applying REBOA distal to the injury site in certain clinical scenarios may sufficiently increase peripheral resistance to compensate temporarily for cardiovascular collapse secondary to aortic injury.
报告一种非常规的使用主动脉腔内修复球囊阻断（REBOA）技术的方法，用于恢复因近端在阻塞目标区域的主动脉损伤而出血的患者的血流动力学稳定性。
一名 72 岁女性因破裂的 8×8cm 真菌性假性动脉瘤而行紧急胸主动脉支架修复术。两个月后，随访影像学显示近端主动脉支架密封区已退化，因此在两个月后进行了经皮手术以预先加强支架主动脉段。在获得股动脉入路后不久，患者病情突然恶化，出现严重低血压，推测是入路并发症所致。在腹腔干上方建立了 REBOA，在麻醉师复苏患者的同时维持平均动脉压。出乎意料的是，血管造影显示降胸主动脉在近端支架移植物上方立即发生破裂。在破裂部位远端充气以维持球囊膨胀，同时治疗患者的低血压。在关注区域迅速放置另一个支架移植物，近端与先前的移植物重叠。一旦主动脉穿孔被封闭，患者的血流动力学就稳定了。正性肌力支持被逐渐减少，REBOA 阻塞导管被放气。主动脉弓和胸主动脉的最终血管造影显示无外渗；肾下主动脉和髂动脉的血管造影显示无损伤证据。
该病例表明，在某些临床情况下，将 REBOA 应用于损伤部位远端可能足以增加外周阻力，暂时补偿因主动脉损伤引起的心血管崩溃。
