Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection

Luo, Yi; Duan, Hong; Liu, Wanglin; Li, Min; Shi, Rui; Zhang, Wenli; Zhou, Yong; Tu, Chongqi

doi:10.1002/jso.23376

Cited by 47 publications

(47 citation statements)

References 17 publications

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“…Our study and some others (7,9,12,15,16,18) did not observe any vascular complications (except one patient in our study experienced occurred groin subcutaneous hematoma for incorrect compression of the puncture site). Typically, the longer the occlusion, the more complications.…”

Section: Follow-up Assessmentssupporting

confidence: 56%

“…Recently, several papers (7,9,12,15,16,18) claimed that occlusions of the lower abdominal aorta can effectively control intraoperative hemorrhage. Mi et al (9) reported that occluding the abdominal aorta with a balloon-dilation catheter effectively reduced intraoperative hemorrhage (blood loss volume was only 100-200 ml) and therefore assisted surgeons in the complete and safe resection of upper sacral tumors.…”

Section: Follow-up Assessmentsmentioning

confidence: 99%

“…Several studies (7,9,12,15,16,18) have reported that occluding the abdominal aorta with a balloon catheter is an effective method to control intraoperative blood loss while also gaining better outcomes and fewer complications.…”

mentioning

confidence: 99%

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Surgical management of sacrococcygeal region giant tumors by use of balloon occlusion abdominal aorta

Gong

Liu²,

Huang³

et al. 2015

Turkish Neurosurgery

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Controlling intraoperative hemorrhage is a very troublesome problem for these giant tumors, but it is of vital significance. When blood loss exceeds the maximum permissive level, it becomes life threatening. The purpose of this study is to report on our successful experience in controlling blood loss through using balloon catheters to occlude the abdominal aorta. Surgical management of large sacral tumors is challenging for surgeons and anesthesiologists, in particular due to extensive hemorrhage, which is often refractory to control strategies (8,10,17,20). Several studies (7,9,12,15,16,18) have reported that occluding the abdominal aorta with a balloon catheter is an effective method to control intraoperative blood loss while also gaining better outcomes and fewer complications.The sacrococcygeal region is a complex anatomical area. The pelvic cavity provides many spaces for tumors to grow to quite a large size before symptoms become obvious (19). RESUlTS: Thirty patients underwent surgery via a posterior approach; these cases included 21 chordomas, 5 schwannomas, and 4 giant cell tumors of bone. Wide resections were performed in 26 patients (86.7%) and margin resections were performed in 4 (13.3%) patients. Most patients' symptoms were relieved through surgery and only nine patients (30%) experienced recurrence of the tumors during follow-up.CONClUSION: Sacrococcygeal region giant tumors are still difficult to treat, especially for malignant tumors. Balloon catheter occlusions of the lower abdominal aorta can notably decreased intraoperative hemorrhage, shorten operation time, and decrease postoperative complications. This method is a good choice for neurosurgeons to manage these giant tumors in the sacral region.

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Section: Follow-up Assessmentssupporting

confidence: 56%

Section: Follow-up Assessmentsmentioning

confidence: 99%

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Surgical management of sacrococcygeal region giant tumors by use of balloon occlusion abdominal aorta

Gong

Liu²,

Huang³

et al. 2015

Turkish Neurosurgery

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“…Ruptures of the occlusion balloon have occasionally been reported as complications of EBO, which can be avoided by monitoring the inflation pressure [6]. There are also reports of the use of REBOA in the setting of postpartum hemorrhage [7], pelvic surgery [8], and hepatobiliary surgery [9]. The use of REBOA in the setting of hemorrhagic shock in trauma population was first reported in 1954 during the Korean War [10], but it has been ignored for a long time due to lack of supportive data, lack of familiarity with the technique, the potential for visceral ischemia with irreversible damage, and the high complication rate (35%) [11].…”

Section: Discussionmentioning

confidence: 99%

“REBOA” – Is it Really Safe? A Case with Massive Intracranial Hemorrhage Possibly due to Endovascular Balloon Occlusion of the Aorta (REBOA)

et al. 2016

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Patient: Female, 86Final Diagnosis: PolytraumaSymptoms: ShockMedication: —Clinical Procedure: Resuscitative endovascular balloon occlusion of the aortaSpecialty: Orthopedics and TraumatologyObjective:Unusual or unexpected effect of treatmentBackground:Non-compressible torso hemorrhage continues to be the leading cause of preventable death in trauma patients. Recent case series report that resuscitative endovascular balloon occlusion of the aorta (REBOA) in the trauma population is a technically feasible method to manage the patients with exsanguinating hemorrhage. On the other hand, it seems that REBOA is being widely promoted prematurely. Complications due to REBOA haven’t been reported much in the literature, and they could have been underestimated.Case Report:An 86-year-old female presented to our emergency department following a pedestrian-vehicle accident. On admission, she was hemodynamically unstable with systolic blood pressure (SBP) of 78 mm Hg. She responded to fluid administration, and computed tomography (CT) scan showed cerebral contusion, subarachnoid hemorrhage, pelvic fracture with contrast extravasation, and thoracic spine fracture. Her condition deteriorated after the CT scan, and she became hemodynamically unstable. REBOA was inserted and inflated. Her blood pressure recovered and even became as high as SBP of 180 mm Hg. Transarterial embolization for pelvic fracture was successfully performed. A subsequent head CT scan showed massive intracranial hemorrhage with penetration to the ventricle, which was fatal. She died on the same day due to cerebral herniation.Conclusions:REBOA is now considered as an alternative to resuscitative thoracotomy or even widely indicated to control hemorrhage. We should be more cautious about using REBOA for polytrauma patients since it could make hemorrhage worse. Further research, assessing its potential complications and safety, will be required to elucidate clear indications for REBOA in trauma populations.

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“…Up to now, there are 9 articles discussing the application of IABO on pelvic and/or sacrum tumors (8-16). 7 articles are case series or singlearm retrospective analysis with 30 cases or less (8-10, 12, 14-16), and 2 articles are retrospective studies with IABO group and non-IABO group (11)(12)(13). All of these authors believed IABO was associated with less intraoperative blood loss and different authors focused on different aspects, such as hemodynamic changes, postoperative complications or the prognosis of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Intra-Aortic Balloon Occlusion for Pelvic and Sacrum Tumors: A Case Series

Sun¹,

Huo²,

Xu³

et al. 2018

J Anesth Perioper Med

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Background: The purpose of this study is to investigate feasibilities of intra-aortic balloon occlusion (IABO) for pelvic and sacrum tumors, focusing on the advantages and precautions of the technique. Methods: From January 2010 to December 2013, among all patients with sacrum or pelvic tumor, 46 underwent surgery adjuvant with IABO. We retrospectively reviewed the medical records of these patients, including characteristics, intraoperative hemorrhage, transfusion, serum potassium, arterial lactic acid, postoperative complication, tumor recurrence or metastasis at a follow-up of 28.2 months. Results: Balloons for 46 patients were successfully placed, and the average intraoperative hemorrhage was 1.8 (1.2-3.0) l. Intraoperatively, arterial lactic acid increased from baseline (1.69±0.68) mmol/l to (2.11±0.82) mmol/l (P=0.17) during occlusion and (3.50±2.70) mmol/l (P=0.02) after deflation. While serum potassium concentration showed a trend of increase, but the change was not significant. Application of the technique helped create a bloodless surgical field and shorten the operative time. 9 patients regained normal defecation, while 2 patients with preoperative numbness of perineum developed new onset urinary and fecal incontinence after surgery. Postoperatively, 5 patients developed wound infection, 1 patient developed lower limb weakness, and 1 patient developed cerebrospinal leak. During 28.2 months' followup, 5 recurrences and 2 metastases occurred. Conclusions: IABO might be a choice to reduce intraoperative bleeding, create a clear view of the anatomical structures, shorten the operative time and limit postoperative complication in resection of pelvic and sacrum tumor. Nevertheless, anesthesiologists and surgeons should be sensitive to hemodynamic parameters, electrolyte balance as well as acid-base balance during the procedure, especially after deflation of the balloon. (Funded by the

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Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection

Cited by 47 publications

References 17 publications

Surgical management of sacrococcygeal region giant tumors by use of balloon occlusion abdominal aorta

Surgical management of sacrococcygeal region giant tumors by use of balloon occlusion abdominal aorta

“REBOA” – Is it Really Safe? A Case with Massive Intracranial Hemorrhage Possibly due to Endovascular Balloon Occlusion of the Aorta (REBOA)

Intra-Aortic Balloon Occlusion for Pelvic and Sacrum Tumors: A Case Series

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