title: Endovascular solutions for the management of penetrating trauma: an update on REBOA and axillo-subclavian injuries.
abstract: OBJECTIVE
  Endovascular procedures continue to gain acceptance as management options for penetrating traumatic injuries. Currently, several areas of potential endovascular application are being investigated. However, the bulk of the literature on this topic is still limited to case series or small retrospective studies. Therefore, we performed a review of the published experience involving the application of endovascular therapy to trauma patients who have sustained penetrating injuries with focus on outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular repair of axillo-subclavian injuries.
  
  
  METHODS
  Published case reports, retrospective and prospective studies of REBOA and axillo-subclavian injuries were systematically reviewed.
  
  
  RESULTS
  A total of 7 studies on REBOA and 10 studies on endovascular repair of axillo-subclavian injuries were included. Overall, REBOA was used as an adjunct for hemorrhage control and resuscitation in patients at risk of cardiopulmonary arrest, preventing further cardiovascular collapse successfully. For axillo-subclavian injuries, endovascular stent placement had efficacy comparable to the traditional open repair.
  
  
  CONCLUSIONS
  REBOA is a safe and effective alternative to open thoracotomy in critically ill trauma patients at risk of death due to torso hemorrhage. Endovascular repair outcomes are comparable to open repair after axillo-subclavian injuries. Long-term results of endovascular repair remain to be defined in this patient population.
authors.affiliation: Michael E. DeBakey Department of Surgery, Division of Vascular Surgery & Endovascular Therapy, Baylor College of Medicine, Houston, TX, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Branco
authors.affiliation: Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Division of Vascular Surgery, David Grant Medical Center, University of California-Davis, 101 Boden Circle, Travis Air Force Base, Davis, CA, USA. jjd3c@yahoo.com.
authors.forename: J J
authors.initials: JJ
authors.lastname: DuBose
mesh_terms: D001011:Aorta / Q000293:injuries*; D001366:Axillary Artery / Q000293:injuries*; D021721:Balloon Occlusion; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D012151:Resuscitation / Q000379:methods; D013348:Subclavian Artery / Q000293:injuries*; D014950:Wounds, Penetrating / Q000628:therapy*
keywords: Axillo-subclavian injuries; Balloon aortic occlusion; Endovascular therapy; Mortality and outcomes; Penetrating trauma; REBOA