Endovascular Resuscitation for Ruptured Abdominal Aortic Aneurysms with Main Stent-Graft and REBOA via Single-Sided Access

Abstract

Background: Aortic balloon occlusion or resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhage control during endovascular aortic repair (EVAR) is a technique that has been used for decades for ruptured  abdominal aortic aneurysms (rAAA). This usually requires bilateral femoral access, however, when only single-sided vascular access can be obtained this complicates the procedure if these techniques are to be used. We present two cases of single-sided vascular access, recently performed at our institution, using simultaneous REBOA and aortic stent-graft placement during EVAR in rAAA.
Method: This is a description of two clinical cases where REBOA and EVAR were performed through single-sided vascular access for the treatment of rAAA at Örebro University Hospital between March 2018 and June 2018.
Conclusion: This case report demonstrates that despite the limitation of single-sided access, an aortic stent-graft can be placed for treatment of a rAAA during continuous aortic occlusion with REBOA, facilitated by using a multidisciplinary EndoVascular resuscitation and Trauma Management (EVTM) team approach.