From the Section of Vascular Surgery (J.L.E.); Morphomics Analysis Group (MAG) (B.A.D., S.R.H., N.C.W., S.A.H., C.-H.C., B.E.R. B.B., S.C.W.), University of Michigan; Department of Surgery (J.M.), University of Maryland; and Division of Acute Care Surgery (S.C.W.), University of Michigan.
J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S138-S145. doi: 10.1097/TA.0000000000002247.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a valuable resuscitative adjunct in a variety of clinical settings. In resource-limited or emergency environments, REBOA may be required with delayed or absent image-guidance or verification. Catheter insertion lengths may be informed by making computed tomography (CT) correlations of skeletal landmarks with vascular lengths.
Between 2000 and 2015 at a single civilian tertiary care center, 2,247 trauma patients with CT imaging were identified, yielding 1,789 patients with adequate contrast opacification of the arterial system in the chest, abdomen, and pelvis. Individual scans were analyzed using MATLAB software, with custom high-throughput image processing algorithms applied to correlate centerline vascular anatomy with musculoskeletal landmarks. Data were analyzed using R version 3.3.
The median centerline distance from the skin access to the aortic bifurcation was longer by 0.3 cm on the right than on the left side. Median aortic zone I length was 21.6 (interquartile range, 20.3-22.9) cm, while zone III was 8.7 (7.8-9.5) cm. Torso extent (TE) correlation to zone I was much higher than that for zone III (R2, 0.58 vs. 0.26 (right) and 0.58 vs. 0.27 (left); p < 0.001). Assuming a 4-cm balloon length, optimal fixed insertion length would be 48 cm and 28 cm for zones I and III (error, 0.4% vs. 33.3%), respectively, although out of zone placements can be reduced if adjusted for TE (error, 0% vs. 26.4%).
Computed tomography morphometry suggests that a fixed REBOA catheter insertion length of 48 cm for zone I and 28 cm for zone III is optimal (on average, for average-height individuals), with improved accuracy by formulaic adjustments for TE. High residual error for zone III placement may require redesign of existing catheter balloon lengths or consideration of the relative risk associated with placing the balloon catheter too low or too high.
Prognostic/epidemiological, level III.
主动脉球囊阻断复苏术（REBOA）在多种临床环境中是一种有价值的复苏辅助手段。在资源有限或紧急情况下，可能需要在缺乏或延迟图像引导或验证的情况下进行 REBOA。可以通过骨骼标志与血管长度的 CT 相关性来确定导管插入长度。
在一个单一的民用三级医疗中心，于 2000 年至 2015 年间，共对 2247 名接受 CT 成像的创伤患者进行了识别，其中 1789 名患者的胸部、腹部和骨盆动脉系统有足够的对比显影。使用 MATLAB 软件对个体扫描进行分析，应用定制的高通量图像处理算法将中心线血管解剖结构与肌肉骨骼标志相关联。使用 R 版本 3.3 对数据进行分析。
右侧皮肤入口至主动脉分叉处的中心线距离比左侧长 0.3 厘米。主动脉区 I 的中位中心长度为 21.6（四分位间距，20.3-22.9）cm，而区 III 为 8.7（7.8-9.5）cm。躯干范围（TE）与区 I 的相关性明显高于区 III（R2，0.58 对 0.26（右侧）和 0.58 对 0.27（左侧）；p<0.001）。假设使用 4cm 的球囊长度，区 I 和区 III 的最佳固定插入长度分别为 48cm 和 28cm（误差，0.4%对 33.3%），尽管如果根据 TE 进行调整，超出区域的放置可以减少（误差，0%对 26.4%）。
CT 形态计量学表明，区 I 的固定 REBOA 导管插入长度为 48cm，区 III 的为 28cm 是最佳的（平均而言，对于平均身高的个体），通过公式调整 TE 可提高准确性。区 III 放置的残余误差较大可能需要重新设计现有的球囊导管长度，或考虑放置球囊导管过低或过高的相对风险。
预后/流行病学，III 级。
