Inappropriate Resuscitative endovascular balloon occlusion of the aorta (REBOA) Catheter Placement in Patient With Unexpected Left Common Iliac Artery Rupture

Abstract

A 70-year-old man came to our facility after a car accident. The vital signs were unstable; blood pressure could not be recorded at the time of arrival. Immediately after arrival, cardiac arrest occurred twice, and resuscitation was successful. In the emergency room, he underwent brief sonographic examination, and a massive fluid collection was observed in the splenorenal recess. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also performed with blind puncture technique during the resuscitation. The balloon was inflated with 25 mL of normal saline, but there was no sense of resistance, which is considered unusual. Placement of the catheter tip was checked with bedside ultrasonography but was not clearly confirmed because of the massive fluid collection. In general, catheter tip placement is confirmed with radiography, fluoroscopy, or ultrasonography (1), but the serious emergency situation precluded these assessments. The patient’s blood pressure recovered to 80/50 mm Hg, and he was moved to the operating room immediately. During the operation, vascular rupture from aortic bifurcation to the left common iliac artery was confirmed (Fig. 1). The REBOA catheter was found to be misplaced: It had been inserted correctly via the femoral artery, but it exited through the ruptured pore of the iliac artery (Fig. 2). We inserted the catheter back into the aorta urgently and then compressed the injured site to control bleeding; however, cardiac arrest continued. The abdomen was closed, the patient was moved to the intensive care unit, and then he was pronounced dead. Brief Image in Trauma eISSN: 2508-8033 pISSN: 2508-5298