Use of intra-aortic balloon occlusion via endovascular techniques was designed for resuscitative use in trauma patients and has been shown to be effective in reducing hemorrhagic shock mortality [Citation1–3]. Use of this device for pelvic and acetabular fractures has been described in the literature to some success, as well as with complex hip and knee revision arthroplasties [Citation4, Citation5].
In this investigation, the authors evaluated the outcomes from a cohort of 43 patients who underwent intra-aortic balloon occlusion for complex acetabular fractures treated in a delayed manner [Citation6]. Delayed acetabular fracture treatment has been shown to be associated with worse outcomes than acute reduction and fixation, including increased blood loss, higher risk of poor reduction quality, as well as increased incidence of heterotopic ossification and infection [Citation7]. Use of intra-aortic balloon occlusion was shown in this investigation to decrease blood loss, allowing the surgeons to work in a less bloody surgical field and complete the procedure in a reasonable amount of time. They make note of the need to let the balloon down to allow reperfusion, and this correlates with existing data that found increased lactate and complication rates with prolonged occlusion times [Citation2]. Reinflation of the balloon appears to be safe upon anecdotal recommendations, including this investigation, but more information is needed to provide optimal timing suggestions regarding reinflation.
Although use of this device for procedures that anticipate significant blood loss is warranted, the specific relative indications are currently limited. Current indications for this procedure would include pelvic or acetabular fractures in patients that are undergoing delayed reconstruction and patients with acetabular or pelvic fractures requiring open fixation that are refusing allogenic blood or use of adjunct treatments such as a cell-saver device. From limited data, it appears that use of this technique for anterior approaches to the pelvis and acetabulum are more beneficial than use of this for posterior-based approaches [Citation5].
This investigation should be lauded for adding a significant amount of data to the literature on this treatment. Further investigation is warranted using this device for acetabular fractures, and this potentially percutaneous technique may prove essential to treatment of many future acetabular fractures.
Declaration of interests
The author has no competing interest to declare.
References
- Tsurukiri J, Akamine I, Sato T, et al. Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting. Scand J Trauma Resusc Emerg Med 2016;24:13. doi: 10.1186/s13049-016-0205-8.
- Sano H, Tsurukiri J, Hoshiai A, Oomura T, Tanaka Y, Ohta S. Resuscitative endovascular balloon occlusion of the aorta for uncontrollable nonvariceal upper gastrointestinal bleeding. World J Emerg Surg 2016;2011:20.
- DuBose JJ, Scalea TM, Brenner M, et al. The AAST prospective aortic occlusion for resuscitation in trauma and acute care surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016;81(3):409–419.
- DiPasquale T, Greiwe RM, Simmons P, et al. Temporary partial intra-iliac balloon occlusion for the treatment of acetabulum fracture in a Jehovah's Witness: a case report. J Orthop Trauma 2005;19(6):415–419.
- Siebler J, Dipasquale T, Sagi HC. Use of temporary partial intrailiac balloon occlusion for decreasing blood loss during open reduction and internal fixation of acetabular and pelvis fractures. J Orthop Trauma. 2012;26(6):e54–e57.
- Kong L, Yu Y, Li F, Cui H. Intra-aortic balloon occlusion decreases blood loss during open reduction and internal fixation for delayed acetabular fractures: A retrospective study of 43 patients. J Invest Surg. 2020;33(5):468–473.
- Zhu SW, Sun X, Yang MH, et al. Long-term outcome of operative management of delayed acetabular fractures. Chin Med J. 2013;126(14):2699–2704.