Comparison of aortic zones for endovascular bleeding control: age and sex differences

Boke Linso Sjirk Borger van der Burg; Suzanne Vrancken; Thijs Theodorus Cornelis Fransiscus van Dongen; Tom Wamsteker; Todd Rasmussen; Rigo Hoencamp

doi:10.1007/s00068-022-02033-7

Comparison of aortic zones for endovascular bleeding control: age and sex differences

Eur J Trauma Emerg Surg. 2022 Dec;48(6):4963-4969. doi: 10.1007/s00068-022-02033-7. Epub 2022 Jul 6.

Authors

Boke Linso Sjirk Borger van der Burg¹, Suzanne Vrancken², Thijs Theodorus Cornelis Fransiscus van Dongen^{2

3}, Tom Wamsteker², Todd Rasmussen⁴, Rigo Hoencamp^{2

3

5

6}

Affiliations

¹ Department of Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands. blsborgervanderburg@alrijne.nl.
² Department of Surgery, Alrijne Hospital Leiderdorp, Simon Smitweg 1, 2353GA, Leiderdorp, The Netherlands.
³ Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.
⁴ Department of Surgery at Mayo Clinic, Rochester, USA.
⁵ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁶ Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Abstract

Purpose: To gain insight into anatomical variations between sexes and different age groups in intraluminal distances and anatomical landmarks for correct insertion of resuscitative endovascular balloon occlusion of the aorta (REBOA) without fluoroscopic confirmation.

Materials: All non-trauma patients receiving a computed tomography angiography (CT-A) scan of the aorta, iliac bifurcation and common femoral arteries from 2017 to 2019 were eligible for inclusion.

Methods: Central luminal line distances from the common femoral artery (CFA) to the aortic occlusion zones were measured and diameters of mid zone I, II and III were registered. Anatomical landmarks and correlations were assessed. A simulated REBOA placement was performed using the Joint Trauma System Clinical Practice Guideline (JTSCPG).

Results: In total, 250 patients were included. Central luminal line (CLL) measurements from mid CFA to aortic bifurcation (p = 0.000), CLL measurements from CFA to mid zone I, II and III (p = 0.000) and zone I length (p = 0.000) showed longer lengths in men. The length of zone I and III (p = 0.000), CLL distance measurements from the right CFA to mid zone I (p = 0.000) and II (p = 0.013) and aortic diameters measured at mid zone I, II and III increased in higher age groups (p = 0.000). Using the JTSCPG guideline, successful deployment occurred in 95/250 (38.0%) in zone III and 199/250 (79.6%) in zone I. Correlation between mid-sternum and zone I is 100%. Small volume aortic occlusion balloons (AOB) have poor occlusion rates in zone I (0-2.8%) and III (4.4-34.4%).

Conclusions: Men and older age groups have longer CLL distances to zone I and III and introduction depths of AOB must be adjusted. The risk of not landing in zone III with standard introduction depths is high and balloon position for zone III REBOA is preferably confirmed using fluoroscopy. Mid-sternum can be used as a landmark in all patient groups for zone I. In older patients, balloon catheters with larger inflation volumes must be considered for aortic occlusion.

Keywords: Aortic zones; External landmark; Fluoroscopy free; REBOA.

MeSH terms

Aged
Aorta, Abdominal
Balloon Occlusion* / methods
Endovascular Procedures* / methods
Female
Hemorrhage / therapy
Humans
Leukemia, Lymphocytic, Chronic, B-Cell*
Male
Sex Characteristics