title: Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta.
abstract: BACKGROUND
  Many hemodynamically stable patients with blunt abdominal solid organ injuries are successfully managed nonoperatively, while unstable patients often require urgent laparotomy. Recently, therapeutic angioembolization has been used in the treatment of intra-abdominal hemorrhage in hemodynamically unstable patients. We undertook this study to review a series of hemodynamically unstable patients with abdominal solid organ injuries managed nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta.
  
  
  METHODS
  The institutional review board approved this study. All patients were appropriately resuscitated with transfusions, and angiography was performed after computed tomography. Resuscitative endovascular balloon occlusion of the aorta was performed before computed tomography in all patients.
  
  
  RESULTS
  Seven patients underwent resuscitative endovascular balloon occlusion of the aorta following severe blunt abdominal trauma. The 28-day survival rate was 86% (6 of 7). There were no complications related to the procedure.
  
  
  CONCLUSIONS
  We describe the first clinical series of hemodynamically unstable patients with abdominal solid organ injury treated nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta. Survival rate was 86%, supporting the need for further study of this modality as an adjunct to the nonoperative management of patients with severe traumatic injuries.
  
  
  METHODS
  Therapeutic study, level V.
authors.affiliation: From the Advanced Medical Emergency Department and Critical Care Center (T.O., M.N.), and Department of Radiology (H.M.), Japan Red Cross Maebashi Hospital, Maebashi, Gunma; and Departments of Surgery (A.T.L.), and Emergency Medicine (Y.I.), Jichi Medical University, Tochigi, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Ogura
authors.forename: Alan T
authors.initials: AT
authors.lastname: Lefor
authors.forename: Minoru
authors.initials: M
authors.lastname: Nakano
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Izawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Morita
mesh_terms: D000007:Abdominal Injuries / Q000503:physiopathology* / Q000628:therapy*; D000368:Aged; D000792:Angiography; D001012:Aorta, Abdominal; D021721:Balloon Occlusion; D001803:Blood Transfusion; D004621:Embolization, Therapeutic; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000503:physiopathology* / Q000628:therapy*