title: A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review.
abstract: BACKGROUND
  EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.
  
  
  OBJECTIVE
  We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.
  
  
  METHODS
  A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.
  
  
  RESULTS
  Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.
  
  
  CONCLUSIONS
  EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden. Tal.horer@regionorebrolan.se.
authors.forename: T M
authors.initials: TM
authors.lastname: Hörer
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Skoog
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Pirouzram
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden.
authors.forename: K F
authors.initials: KF
authors.lastname: Nilsson
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Larzon
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D021721:Balloon Occlusion / Q000379:methods; D002985:Clinical Protocols; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D017410:Practice Guidelines as Topic; D012771:Shock, Hemorrhagic / Q000517:prevention & control*
keywords: Access; Angiography; Endovascular treatment; Hemorrhagic shock; Intra-aortic balloon occlusion; Trauma