Abstract
Background
Endovascular balloon occlusion of the aorta (EBOA) increases proximal arterial pressure but may also induce life-threatening ischemic complications. Although partial REBOA (P-REBOA) mitigates distal ischemia, it requires invasive monitoring of femoral artery pressure for titration. In this study, we aimed to titrate P-REBOA to prevent high-degree P-REBOA using ultrasound assessment of femoral arterial flow.
Methods
Proximal (carotid) and distal (femoral) arterial pressures were recorded, and perfusion velocity of distal arterial pressures was measured by pulse wave Doppler. Systolic and diastolic peak velocities were measured among all ten pigs. Total REBOA was defined as a cessation of distal pulse pressure, and maximum balloon volume was documented. The balloon volume (BV) was titrated at 20% increments of maximum capacity to adjust the degree of P-REBOA. The distal/proximal arterial pressure gradient and the perfusion velocity of distal arterial pressures were recorded.
Results
Proximal blood pressure increased with increasing BV. Distal pressure decreased with increasing BV, and distal pressure sharply decreased by > 80% of BV. Both systolic and diastolic velocities of the distal arterial pressure decreased with increasing BV. Diastolic velocity could not be recorded when the BV of REBOA was > 80%.
Conclusion
The diastolic peak velocity in the femoral artery disappeared when %BV was > 80%. Evaluation of the femoral artery pressure by pulse wave Doppler may predict the degree of P-REBOA without invasive arterial monitoring.
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Data availability
The data that support the findings of this study are available from the corresponding author, YM, upon reasonable request.
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Funding
This study was supported in part by ZENKYOREN (National Mutual Insurance Federation of Agricultural Cooperatives), 2021–2022.
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Corresponding author YM. Study concept, design MA, YM, YI. Data collection and analysis: MA, YM, YI, YH. Writing: MA, YM. Critical revision: YM, YI, YH.
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All procedures were approved by the Centre for Development of Advanced Medical Technology from Jichi Medical University.
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Aoki, M., Matsumura, Y., Izawa, Y. et al. Ultrasound assessment is useful for evaluating balloon volume of resuscitative endovascular balloon occlusion of the aorta. Eur J Trauma Emerg Surg 49, 2479–2484 (2023). https://doi.org/10.1007/s00068-023-02309-6
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DOI: https://doi.org/10.1007/s00068-023-02309-6