Transbrachial arterial insertion of aortic occlusion balloon catheter in patients with shock from ruptured abdominal aortic aneurysm.
OBJECTIVE
Of 125 surgical patients with abdominal aortic aneurysm (AAA) treated from 1999, 11 patients with deep shock from ruptured AAAs who underwent aortic occlusion balloon catheter (AOBC) insertion before laparotomy were studied.


METHODS
With the patients under local anesthesia, the brachial artery was exposed and the balloon catheter was inserted into the thoracic aorta. The balloon was inflated halfway and pulled back gently to the orifice of the left subclavian artery, and was advanced with the aid of blood flow down to the abdominal aorta. After full inflation of the balloon, the catheter was pulled until the balloon was fixed at the proximal shoulder of the AAA.


RESULTS
AOBC insertion was completed within 16.1 +/- 5.1 minutes. Systolic blood pressure at presentation was 84.1 +/- 31.7 mm Hg, deteriorated to 60.9 +/- 15.4 mm Hg on arrival in the operating room, and increased significantly (P <.0001) to 123.4 +/- 25.3 mm Hg after AOBC insertion. The balloon burst in three patients. Embolic complications were observed in two patients. There were three deaths, two associated with the balloon bursting. In nine patients whose shock was successfully controlled by AOBC, operative mortality was 11%.


CONCLUSIONS
Transbrachial arterial insertion of an AOBC may be useful to ameliorate hemorrhagic shock in patients with ruptured AAAs.
Matsuda
Hitoshi
H
Tanaka
Yosuke
Y
Hino
Yutaka
Y
Matsukawa
Ritsu
R
Ozaki
Nobuchika
N
Okada
Kenji
K
Tsukube
Takuro
T
Tsuji
Yoshihiko
Y
Okita
Yutaka
Y
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications* / Q000503:physiopathology; D001019:Aortic Rupture / Q000150:complications* / Q000503:physiopathology; D021721:Balloon Occlusion / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology; D001916:Brachial Artery / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome