Successful management for a ruptured abdominal aortic aneurysm using resuscitative endovascular balloon occlusion of the aorta via the brachial artery route—a case report

Abstract

Ruptured abdominal aortic aneurysms pose a challenge to anesthesiologists. Resus-citative thoracotomy and aorta-cross clamping are used to prevent cardiopulmonary collapse during ruptured abdominal aortic aneurysm repair. Recently, resuscitative endovascular balloon obstruction of the aorta has been introduced as an alternative to resuscitative thoracotomy and aorta-cross clamping. Resuscitative endovascular balloon obstruction of the aorta is a minimally invasive and low risk procedure compared to resuscitative thoracotomy and aorta-cross clamping, with minimal blood-borne pathogen exposure to healthcare workers. A 63-year-old man was scheduled for emergency repair of a ruptured abdominal aortic aneurysms. The patient’s vital signs were unstable, and aggressive treatment with transfusion and vasopressor infusion was not effective. Resuscitative endovascular balloon obstruction of the aorta was performed using the brachial artery. After initiation of resuscitative endovascular balloon obstruction of the aorta, the patient’s vital signs immediately stabilized, and hematoma evacuation and aorta reconstruction were completed successfully. The total balloon inflation time during resuscitative endovascular balloon obstruction of the aorta was approximately 45 min. The patient was discharged on the 62nd postoperative day. Resuscitative endovascular balloon obstruction of the aorta is a promising minimally invasive alternative to resuscitative thoracotomy and aorta-cross clamping in patients with ruptured abdominal aortic aneurysms. Resuscitative endovascular balloon obstruction of the aorta may also be a good treatment option for patients with non-compressible torso bleeding under the diaphragm.