Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 7 , ISSUE 2 ( May-August, 2018 ) > List of Articles

RESEARCH ARTICLE

Three Sequential Balloon Catheters for Vascular Exclusion of the Liver and Aortic Control (one REBOA and two REBOVCs): A Hemorrhage Control Strategy in Suprahepatic Vena Cava Injuries

Joao B Rezende-Neto, Ghassan Al-Kefeiri, Matt Strickland, Vikram Prabhudesai, Sandro B Rizoli, Ori Rotstein

Keywords : Endovascular balloon, Hemorrhage control, Suprahepatic, Vena cava injury

Citation Information : Rezende-Neto JB, Al-Kefeiri G, Strickland M, Prabhudesai V, Rizoli SB, Rotstein O. Three Sequential Balloon Catheters for Vascular Exclusion of the Liver and Aortic Control (one REBOA and two REBOVCs): A Hemorrhage Control Strategy in Suprahepatic Vena Cava Injuries. Panam J Trauma Crit Care Emerg Surg 2018; 7 (2):114-122.

DOI: 10.5005/jp-journals-10030-1214

License: CC BY-NC 4.0

Published Online: 01-08-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: We hypothesized that sequential deployment of a resuscitative endovascular balloon occlusion in the aorta REBOA, Pringle maneuver, and two Resuscitative balloon occlusion of the inferior vena cava (REBOVC) would provide hepatic vascular exclusion and hemorrhage control. Materials and Methods: Hemodynamic monitoring and splenectomy were performed in seven swine. One REBOA device and two REBOVCs were positioned under fluoroscopy in the thoracic aorta, suprahepatic and infrahepatic inferior vena cava (IVC); 35% of the total blood volume was removed. Hepatic vascular exclusion was performed for 15 minutes during shock through sequential deployment of the REBOA in the thoracic aorta, Pringle maneuver, the REBOVC in the infrahepatic IVC, and the REBOVC in the suprahepatic IVC. Hepatic vascular exclusion was reversed in the following sequence: Deflation of the REBOVC in the suprahepatic IVC, followed by the infrahepatic IVC REBOVC, release of the Pringle, and deflation of the REBOA. Subsequently, a 1.5 cm injury was performed in the suprahepatic IVC. Immediately thereafter, hepatic vascular exclusion was performed for 15 minutes followed by reversal of exclusion; suture repair of the injury was performed in two animals. Results: Hepatic vascular exclusion effectively stopped the bleeding from the suprahepatic IVC injury, significantly increased MAP. The procedure did not aggravate shock assessed by pH, lactate and base excess, and hemodynamics. Reversal of the exclusion led to immediate exsanguination from the suprahepatic IVC injury except after suture repair of the injury. Conclusion: Sequential deployment of REBOA, Pringle maneuver and two REBOVCs provided vascular exclusion of the liver and effectively temporized the hemorrhage from the suprahepatic IVC. Clinical Significance: Vascular exclusion of the liver during operative repair is difficult in the setting of massive bleeding. The procedure described herein is less invasive and effectively controls the bleeding.


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  1. Buckman RF, Miraliakbari R, Badellino MM. Juxtahepatic venous injuries: a critical review of reported management strategies. J Trauma. 2000 May;48(5):978-984.
  2. Richardson JD, Franklin GA, Lukan JK, Carrillo EH, Spain DA, Miller FB, et al. Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg. 2000 Sep;232(3): 324-330.
  3. Bardes JM, Grabo D, Lam L, Tadlock MD, Strumwasser A, Inaba K. Treatment algorithm and management of retrohepatic vena cava injuries. J Trauma Acute Care Surg. 2017 Aug;83(2):340-344.
  4. Schrock T, Blaisdell FW, Mathewson C. Management of blunt trauma to the liver and hepatic veins. Arch Surg. 1968 May;96 (5):698-704.
  5. Burch JM, Feliciano DV, Mattox KL. The atriocaval shunt: facts and fiction. Ann Surg. 1988 May;207(5):555-568.
  6. Aaron WS, Mays ET. Isolation of the retrohepatic vena cava by balloon catheter: an experimental assessment. Rev Surg. 1975 May-Jun; 32(3):222-225.
  7. Pilcher DB, Harman PK, Moore EE Jr. Retrohepatic vena cava balloon shunt introduced via the sapheno-femoral junction. J Trauma. 1977 Nov;17(11):837-841.
  8. Baumgartner F, Scudamore C, Nair C, Karusseit O, Hemming A. Venovenous bypass for major hepatic and caval trauma. J Trauma. 1995 Oct;39(4):671-673.
  9. Venovenous bypass and hepatic vascular isolation as adjunct in the repair of destructive wounds to the retrohepatic inferior vena cava. J Trauma. 1998 Aug;45(2):400-403.
  10. Rogers FB, Reese J, Shackford SR, Osler TM. The use of Venovenous bypass and total vascular isolation of the liver in the surgical management of juxtahepatic venous injuries in blunt hepatic trauma. J Trauma. 1997 Sep;43(3):530-533.
  11. Testas P, Benichou J, Benhamou M, Chanzy M. Vascular exclusion in surgery of the liver: experimental basis, technic, and clinical results. Am J Surg. 1977 Jun;133(6):692-696.
  12. Coimbra R, Hoyt DB, Engelhart S, Fortlage D. Nonoperative management reduces the overall mortality of grades 3 and 4 blunt liver injuries. Int Surg. 2006 Sep-Oct;91(5):251-257.
  13. Liu PP, Chen CL, Cheng YF, Hsieh PM, Tan BL, Jawan B, et al. Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries. J Trauma. 2005 Oct;59(4):940-245.
  14. Khaneja SC, Pizzi WF, Barie PS, Ahmed N. Management of penetrating juxtahepatic inferior vena cava injuries under total vascular exclusion. J Am Coll Surg. 1997 May;184(5): 469-474.
  15. Bisulli M. Gamberini E, Coccolini F, Scognamiglio G, Agnoletti V. Resuscitative endovascular balloon occlusion of vena cava (REBOVC): an option in managing traumatic vena cava injuries. J Trauma Acute Care Surg. 2018 Jan;84(1)211-213.
  16. Bui TD, Mills JL. Control of inferior vena cava injury using percutaneous balloon catheter occlusion. Vasc Endovascular Surg. 2009 Oct-Nov;43(5):490-493.
  17. Lallemand MS, Moe DM, McClellan JM, Smith JP, Daab L, Marko S, et al. Resuscitative endovascular balloon occlusion of the aorta for major abdominal venous injury in a porcine hemorrhagic shock model. J Trauma Acute Care Surg. 2017 Aug;83(2):1054-1058.
  18. Reynolds CL, Celio AC, Bridges LC, Mosquera C, O'Connell B, Bard MR, et al. REBOA for the IVC? Resuscitative balloon occlusion of the inferior vena cava (REBOVC) to abate massive hemorrhage in retrohepatic vena cava injuries. J Trauma Acute Care Surg. 2017 Dec;83(6):1041-1046.
  19. Russo RM, Williams TK, Grayson JK, Lamb CM, Cannon JW, Clement NF, et al. Extending the golden hour: partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model. J Trauma Acute Care Surg. 2016 Mar;80(3):372-380.
  20. Ordoñez CA, Herrera-Escobar JP, Parra MW, Rodrigues-Ossa PA, Puyana JC. A severe traumatic juxtahepatic blunt venous injury. J Trauma and Acute Care Surg. 2016 Apr;80(4):674-676.
  21. White JM, Cannon JW, Stannard A, Markov NP, Spencer JR, Rasmussen TE. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in porcine model of hemorrhagic shock. Surgery. 2011 Sep;150(3):400-409.
  22. Edwards WS, Salter PP Jr., Carnaggion VA. Intraluminal aortic occlusion as a possible mechanism for controlling massive intra-abdominal hemorrhage. Surg Forum. 1953 Oct;4:496- 499.
  23. Hughes CW. Use of intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954 Jul;36(1):65-68.
  24. Brenner ML, Moore LJ, DuBose JJ, Tyson GH, McNutt MK, Albarado RP, et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013 Sep;75(3):506-511.
  25. DuBose JJ, Scalea TM, Brenner M, Skiada D, Inaba K, Cannon J, et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016 Sep;81(3):409-419.
  26. Gupta BK, Khaneja SC, Flores L, Eastlick L, Longmore W, Shaftan GW. The role of intra-aortic balloon occlusion in penetrating trauma. J Trauma. 1989 Jun;29(6):861-865.
  27. Miura F, Takada T, Ochiai T, et al. Aortic occlusion balloon catheter technique is useful for uncontrollable massive intraabdominal bleeding after hepato-pancreato-biliary surgery. J Gastrointest Surg. 2006 Apr;10(4):519-522.
  28. Moore LJ, Brenner M, Kozar RA, Pasley J, Wade CE, Baraniuk MS, et al. Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg. 2015 Oct;79(4):523-532.
  29. Doty DB, Berman JR. Control of hepatic venous bleeding by transvenous balloon catheter. Surg Gynecol Obstet. 1970 Sep;131(3):449-452.
  30. McAnena OJ, Moore EE, Moore FA. Insertion of a retrohepatic vena cava balloon shunt through the saphenofemoral junction. Am J Surg. 1989 Nov;158(5):463-66.
  31. Millikan JS, Moore EE, Cogbill TH, Kashuk JL. Inferior vena cava injuries – A continuing challenge. J Trauma. 1983 Mar;23(3):207-212.
  32. Nicoluzzi JE, Von Bhaten LC, Laux G. Hepatic vascular isolation in treatment of a complex hepatic vein injury. J Trauma. 2007 Sep;63(3):684-686.
  33. Ledgerwood AM, Kazmers M, Lucas CE. The role of thoracic aortic occlusion for massive hemoperitoneum. J Trauma. 1976 Aug;16(8):610-15.
  34. Sankaran S, Lucas C, Walt AJ. Thoracic aortic clamping for prophylaxis against sudden cardiac arrest during laparotomy for acute massive hemoperitoneum. J Trauma. 1975 Apr;15(4):290-296.
  35. Kralovich KA, Morris DC, Dereczyk BE, Simonetti V, Williams M, Rivers EP, et al. Hemodynamic effects of aortic occlusion during hemorrhagic shock and cardiac arrest. J Trauma. 1997 Jun;42(6):1023-1028.
  36. Markov NP, Percival TJ, Morrison JJ, Ross JD, Scott DJ, Spencer JR. Physiologic tolerance of descending thoracic aortic balloon occlusion in swine model of hemorrhagic shock. Surgery. 2013 Jun;153(6):848-856.
  37. Williams TK, Neff LP, Johnson MA, Ferencz SA, Davidson AJ, Russo RM, et al. Extending resuscitative endovascular balloon occlusion of the aorta: endovascular variable aortic control in a lethal model of hemorrhagic shock. J Trauma Acute Care Surg. 2016 Aug;81(2):294-301.
  38. Bismuth H, Castaing D, Garden OJ. Major hepatic resection under total vascular exclusion. Ann Surg. 1989 Jul;210(1): 13-19.
  39. Delva E, Barberousse JP, Nordinger B, Ollivier JM, Vacher B, Guilmet C, et al. Hemodynamic and biochemical monitoring during major hepatic resection with use of hepatic vascular exclusion. Surgery. 1984 Mar; 95(3):309-318.
  40. Offenstadt G, Huguet C, Gallot D, Bloch P. Hemodynamic monitoring during complete vascular exclusion for extensive hepatectomy. Surg Gynecol Obstet. 1978 May;146(5):709-713.
  41. Bogert JN, Patel BM, Johnson DJ. Ultrasound optimization for resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2017 Jan;82(1):204-207.
  42. Sokol KK, Black GE, Willey SB, Kniery K, Marko ST, Eckert MJ, et al. There's an app for that: a handheld smartphonebased infrared imaging device to assess adequacy and level of aortic occlusion during REBOA. J Trauma Acute Care Surg.2017 Jan;82(1)102-108.
  43. Avaro JP, Mardelle V, Roch A, Gil C, de Biasi C, Oliver M, et al. Forty-minute endovascular aortic occlusion increases survival in an experimental model of uncontrolled hemorrhagic shock caused by abdominal trauma. J Trauma. 2011 Sep;71(3):720-772.
  44. Evans PM, Vogt DP, Mayes JT 3rd, Henderson JM, Walsh RM. Liver resection using total vascular exclusion. Surgery. 1988 Oct;124(4):807-813.
  45. van Riel WG, van Golen RF, Reiniers MJ, Heger M, van Gulik TM. How much ischemia can the liver tolerate during resection? Hepatobiliary Surg Nutr. 2016 Feb; 5(1):58-71.
  46. Yellin AE, Chaffee CB, Donovan AJ. Vascular isolation in treatment of juxtahepatic venous injuries. Arch Surg. 1971 Jun;102(6):566-573.
  47. Saito N, Matsumoto H, Yagi T, Hara Y, Hayashida K, Motomura T, et al. Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2015 May;78(5):897-903.
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