Vascular Complications Secondary to Resuscitative Endovascular Balloon Occlusion of the Aorta Placement at a Level 1 Trauma Center

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is designed to manage severe hemorrhagic shock. Popularized in medical care during military conflicts, the concept emerged as a lifesaving technique that is used in the United States. Literature on the risks of REBOA placement, especially vascular injuries, are not well-reported. Our goal was to assess the incidence of vascular injury from REBOA placement, risk factors associated with injury and the incidence of death among these patients at our institution. We performed a retrospective cohort study of all patients who underwent REBOA placement between September 2017 and June 2022 in our level trauma center. The primary outcome variable was the presence of an injury related to REBOA insertion or use. Secondary outcomes studied were limb loss and mortality. Data were analyzed using descriptive statistics, χ2, and t tests as appropriate for the variable type. We identified 99 consecutive patients who underwent REBOA placement during the study period. The mean age of patients was 43 years (range, 13-84 years) and 67.7% (67/99) were male. The majority of injuries were from blunt trauma (79.8% [79/99]). Twelve patients (12.1%) had a vascular injury related to REBOA placement that required emergent intervention. All but one of the injuries were identified within 4 hours of REBOA placement. The delayed repair was a pseudoaneurysm that was repaired 10 days after REBOA placement. The complications included local vessel injury in 58.3% (7/12), distal embolization in 16.7% (2/12), excessive bleeding requiring vascular consultation in 8.3% (1/12), pseudoaneurysm requiring intervention in 8.3% (1/12). and one incident of inability to remove REBOA device (8.3% [1/12]). The repairs were performed by vascular surgery (75% [9/12]), interventional radiology (16.7% [2/12]), and trauma surgery (8.3% [1/12]). There was no association of age, gender, race, or blunt versus penetrating injury to REBOA related complications. Mortality in this patient population was high (40.4%), but there was no association with REBOA-related complications. Ipsilateral limb loss occurred in two patients, but both were related to their injuries and not to REBOA-related ischemia. Although vascular complications are not unusual, there does not seem to be an association with limb loss or mortality if they are addressed promptly. Close coordination between vascular surgeons and trauma surgeons is essential in patients undergoing REBOA placement.