Citation Information :
Ribeiro Jr MA, Belardim CM, Pastori RD, Pinho AJ, Custódio CG, Niero HB, Rodrigues JM, Ordoñez C. Evaluating the use of Resuscitative Endovascular Balloon Occlusion of the Vena Cava (REBOVC) in Retrohepatic Vena Cava Injuries: Indications Technical Aspects and Outcomes. Panam J Trauma Crit Care Emerg Surg 2022; 11 (1):9-13.
Aim: Vena cava injuries are a major challenge for trauma surgeons due to their difficult-to-access anatomical site. In addition, their complex operative management often requires prohibitive time for damage control purposes. Considering this scenario, endovascular techniques, such as endovascular occlusion devices, have been increasingly applied to treat such injuries. Resuscitative endovascular balloon occlusion of the vena cava (REBOVC) stands out as a promising technique to manage hemodynamically unstable patients - depending on the anatomical site of the injuries and the complexity of the access to them—since it enables temporary bleeding control to stabilize patients’ conditions.
Methods: Based on a literature review about the use of REBOVC to manage venous bleeding deriving from the inferior vena cava (IVC). Four experimental studies were conducted with animal models, one descriptive study about the principles of occlusion in artificial models and four case reports were evaluated.
Results: REBOVC helped shorten the time necessary for bleeding control and increased the likelihood of achieving effective treatment in cases of potentially lethal bleeding, as well as reduced mortality rates.
Conclusion: REBOVC is a promising endovascular technique that can be used in a safer and more objective way to promote a new paradigm in IVC trauma scenarios to help to control bleeding and reduce its consequences.
Kragh JF Jr, Littrel ML, Jones JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med 2011;41(6):590–597. DOI: 10.1016/j.jemermed.2009.07.022
Qasim Z, Brenner M, Menaker J, et al. Resuscitative endovascular balloon occlusion of the aorta. Resuscitation 2015(96):275–279. DOI: http://dx.doi.org/10.1016/j.resuscitation.2015.09.003
Parreira JG, Soldá SC, Rasslan S. Assessing the risk of death due to hemorrhage in victims of penetrating trauma to the torso admitted in shock: an objective method to select candidates for damage control. Rev Col Bras Cir 2002;29(5):256-266. DOI: https://doi.org/10.1590/S0100-69912002000500003
Kobayashi LM, Costantini TW, Hamel MG, et al. Abdominal vascular trauma. Trauma Surg Acute Care Open 2016;1(1):e000015. DOI: 10.1136/tsaco-2016-000015
Rehman ZU. Inferior vena cava injuries - a clinical review. J Pak Med Assoc 2020;70(6):1069–1071. DOI: 10.5455/JPMA.21107
Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60(6):S3–S11. DOI: 10.1097/01.ta.0000199961.02677.19
Bardes JM, Grabo D, Lam L, et al. Treatment algorithm and management of retrohepatic vena cava injuries. J Trauma Acute Care Surg 2017;83(2):340–344. DOI: 10.1097/TA.0000000000001538
Ribeiro MAF Jr, Feng CYD, Nguyen ATM, et al. The complications associated with resuscitative endovascular balloon occlusion of the aorta (REBOA). World J Emerg Surg 2018;13:20. DOI: 10.1186/s13017-018-0181-6
Ordoñez CA, Parra MW, Caicedo Y, et al. REBOA as a new damage control component in hemodynamically unstable noncompressible torso hemorrhage patients. Colomb Med (Cali) 2020;51(4): e4064506. DOI: 10.25100/cm.v51i4.4422.4506
Ordoñez CA, Parra WP, Serna JL, et al. Damage control resuscitation: REBOA as the new fourth pillar. Colomb Med (Cali) 2020;51(4): e–4014353. DOI: 10.25100/cm.v51i4.4353
Reynolds CL, Celio AC, Bridges LC, 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;83(6):1041–1046. DOI: 10.1097/TA.0000000000001641
Wikström MB, Krantz J, Hörer TM, et al. Resuscitative endovascular balloon occlusion of the inferior vena cava is made hemodynamically possible by concomitant endovascular balloon occlusion of the aorta-A porcine study. J Trauma Acute Care Surg 2020;88(1):160–168. DOI: 10.1097/TA.0000000000002467
Wikström MB, Smårs M, Karlsson C, et al. A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock. J Trauma Acute Care Surg 2021;90(5):817–826. DOI: 10.1097/TA.0000000000003098
Rezende-Neto JB, Al-Kefeiri G, Strickland M, et al. 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
Bui TD, Mills JL. Control of inferior vena cava injury using percutaneous balloon catheter occlusion. Vasc Endovascular Surg 2009;43(5):490–493. DOI: 10.1177/1538574409339939
Ordoñez CA, Parra M, Millan M, et al. Damage control in penetrating liver trauma: fear of the unknown. Colomb Med (Cali) 2020;51(4): e-4134365. DOI: 10.25100/cm.v51i4.4422.4365
Castelli P, Caronno R, Piffaretti G, et al. Emergency endovascular repair for traumatic injury of the inferior vena cava. Eur J Cardiothorac Surg 2005;28(6):906–908. DOI: 10.1016/j.ejcts.2005.09.001
Bisulli M, Gamberini E, Coccolini F, et al. Resuscitative endovascular balloon occlusion of vena cava: An option in managing traumatic vena cava injuries. J Trauma Acute Care Surg 2018;84(1):211–213. DOI: 10.1097/TA.0000000000001707
Ordoñez CA, Herrera-Escobar JP, Parra MW, et al. A severe traumatic juxtahepatic blunt venous injury. J Trauma Acute Care Surg 2016; 80(4):674–676. DOI: 10.1097/TA.0000000000000979