{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T17:24:54Z","timestamp":1758475494331},"reference-count":7,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2018,7,24]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become an increasingly popular alternative to emergency thoracotomy and aortic cross-clamping in patients with exsanguinating hemorrhage.1 This new capability is increasingly being used in non-trauma situations.2 3 This report demonstrates another novel use of REBOA for iatrogenic intra-abdominal hemorrhage.<\/jats:p>An 83-year-old man with multiple medical comorbidities and a history of chronic mesenteric ischemia was admitted to our institution for an elective mesenteric revascularization. Revascularization was unsuccessful, despite attempts to cross the lesion. Postprocedure, the patient developed a right groin hematoma, and CT on postprocedure day 0 demonstrated a femoral artery pseudoaneurysm and subintimal contrast at the level of the celiac artery, representing an iatrogenic dissection.<\/jats:p>The following day, he complained of dizziness. Physical examination revealed a blood pressure of 68\/35 mm Hg, heart rate of 100 beats per minute, and a distended abdomen. Because the surgical intensive care unit (SICU) was full, he was transferred to the neurotrauma intesive care unit (NTICU) and intubated for hemodynamic instability. A chest X-ray revealed a prior thoracic endovascular aortic repair (figure 1), but no intrathoracic hemorrhage or pathology. Bedside ultrasonography revealed intra-abdominal fluid. Laboratory workup showed hemoglobin of 6.1 g\/dL, from 10.9 the previous day. The patient was given two units of packed red blood cells, without response. The intensive care unit (ICU) team initiated norepinephrine, with minimal improvement despite increasing doses.Figure 1<\/jats:label>Chest X-ray with catheter in zone 1. Arrows mark the proximal and distal markers of the resuscitative endovascular balloon occlusion of the aorta.<\/jats:p><\/jats:caption><\/jats:fig><\/jats:p>What would you do?<\/jats:title>Transfuse two units of packed red blood cells and observe.<\/jats:p><\/jats:list-item>Proceed to the operating room (OR) for exploratory laparotomy.<\/jats:p><\/jats:list-item>Endovascular balloon occlusion of the aorta (zone 1).<\/jats:p><\/jats:list-item><\/jats:list><\/jats:sec>","DOI":"10.1136\/tsaco-2018-000165","type":"journal-article","created":{"date-parts":[[2018,10,2]],"date-time":"2018-10-02T05:09:37Z","timestamp":1538456977000},"page":"e000165","update-policy":"http:\/\/dx.doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Use of REBOA to stabilize in-hospital iatrogenic intra-abdominal hemorrhage"],"prefix":"10.1136","volume":"3","author":[{"given":"Christopher J","family":"Goodenough","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler A","family":"Cobb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John B","family":"Holcomb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,10,1]]},"reference":[{"key":"2024051311052193000_3.1.e000165.1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001079"},{"key":"2024051311052193000_3.1.e000165.2","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1016\/j.jvs.2017.05.138","article-title":"Successful use of resuscitative endovascular balloon occlusion of the aorta in the treatment of ruptured 8.5-cm splenic artery aneurysm","volume":"66","author":"Ologun","year":"2017","journal-title":"J Vasc Surg"},{"key":"2024051311052193000_3.1.e000165.3","doi-asserted-by":"crossref","first-page":"519-526","DOI":"10.1007\/s00068-017-0840-4","article-title":"Expanding the field of acute care surgery: a systematic review of the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in cases of morbidly adherent placenta","volume":"44","author":"Manzano-Nunez","year":"2018","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2024051311052193000_3.1.e000165.4","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31829e5416"},{"key":"2024051311052193000_3.1.e000165.5","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000609"},{"issue":"1 Suppl 1","key":"2024051311052193000_3.1.e000165.6","doi-asserted-by":"crossref","first-page":"S120","DOI":"10.1097\/TA.0000000000001514","article-title":"Vascular complications from resuscitative endovascular balloon occlusion of the aorta: life over limb?","volume":"83","author":"Taylor","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2024051311052193000_3.1.e000165.7","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000614"}],"container-title":["Trauma Surgery & Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2018-000165","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T18:12:24Z","timestamp":1715623944000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2018-000165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,10,1]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1136\/tsaco-2018-000165"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2018-000165","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}