Ruptured abdominal aortic aneurysm managed using resuscitative endovascular balloon occlusion of the aorta with a two-stage approach

IF 1.5 Q2 MEDICINE, GENERAL & INTERNAL Acute Medicine & Surgery Pub Date : 2025-02-21 DOI:10.1002/ams2.70048

Kenichiro Ishida, Yosuke Matsumura, Kai Kitabayashi, Haruka Ogawa, Masashi Tajiri, Koichi Ochi, Takashi Iehara, Masaya Nakagawa, Yukie Shirasaki, Hiroyuki Nishi, Mitsuo Ohnishi

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Abstract

Background

A ruptured abdominal aortic aneurysm (rAAA) is fatal. While Resuscitative endovascular balloon occlusion of the aorta (REBOA) contributes to hemodynamic stability, organ ischemia should be carefully considered.

Case Presentation

A 69-year-old obese man with untreated hypertension presented with sudden back pain and hypotension. Computed tomography confirmed the presence of an rAAA. REBOA was initially planned in Zone 1 via the left brachial artery but was eventually switched to Zone 3 via the right femoral artery. Hemodynamic stability was achieved through blood transfusion and partial REBOA, followed by surgical intervention. The postoperative recovery was uneventful.

Conclusion

Zone 1 REBOA via the left brachial approach provided safe aortic occlusion. Transitioning to Zone 3 REBOA, combined with meticulous organ perfusion management and blood transfusion, prevented ischemia–reperfusion complications.

Abstract Image