Computed tomography imaging of resuscitative endovascular balloon occlusion of the aorta (REBOA): pearls and pitfalls

Aoki, Ryo; Kobayashi, Yusuke; Nawata, Shintaro; Kamide, Hiroyuki; Yamamoto, Toh; Furugori, Shintaro; Sekikawa, Zenjiro; Utsunomiya, Daisuke

doi:10.1007/s11604-021-01166-w

Cited by 4 publications

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“…Furthermore, it should be noted that contrast-enhanced computed tomography (CT) may not demonstrate the extravasation of contrast medium as a result of temporary hemostasis of active bleeding by REBOA (Fig. 3 ) [ 10 , 11 ]. In particular, the flow of the contrast medium into the site of active bleeding may be slowed due to the balloon occlusion, resulting in “hidden” bleeding (Fig.…”

Section: Types Of Vascular Injuriesmentioning

confidence: 99%

Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience

et al. 2022

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Pelvic fractures are common in cases of blunt trauma, which is strongly associated with mortality. Transcatheter arterial embolization is a fundamental treatment strategy for fatal arterial injuries caused by blunt pelvic trauma. However, vascular injuries due to blunt pelvic trauma can show various imaging findings other than arterial hemorrhage. We present a pictorial review of common and uncommon vascular injuries, including active arterial bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, vasospasm, and active venous bleeding. Knowledge of these vascular injuries can help clinicians select the appropriate therapeutic strategy and thus save lives.

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Section: Types Of Vascular Injuriesmentioning

confidence: 99%

Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience

et al. 2022

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“…REBOA may cause perfusion-related and procedure-related complications . Perfusion-related complications include distal ischemia reperfusion injury and exacerbation of intracranial bleeding.…”

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Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage

Aoki

2024

JAMA

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patent to estimate the maximum added exclusivity the REMS patents could provide.For each drug, we identified the number of REMS patents the generic manufacturers challenged and the outcome of the challenges. Analyses were performed using Excel, version 16 (Microsoft).Results | Of 24 novel small-molecule drugs covered by active, non-class-wide REMS, 5 (21%) had Orange Book-listed REMS patents: alvimopan (Entereg), lenalidomide (Revlimid), pomalidomide (Pomalyst), sodium oxybate (Xyrem), and thalidomide (Thalomid). There was a median of 10 (range, 2-14) REMS patents per drug, comprising a median of 33% (range, 32%-70%) of all patents per drug, which was higher than the median number of active ingredient (1 [range, 0-2]; 5% [range, 0%-17%]), formulation (3 [range, 1-6]; 17% [range, 5%-30%]), or method-of-use (5 [range, 2-15]; 33% [range, 20%-50%]) patents per drug (Table ).Generic entry had occurred for 2 drugs by 2022. For lenalidomide, the date of first generic marketing was 16 months after expiration of the last-expiring REMS patent and 28 months after expiration of the closest expired non-REMS patent. For alvimopan, the date of first generic marketing was more than 9 years before expiration of the last-expiring REMS patent and 3 days after expiration of the first method-of-use patent (Figure). Among drugs with no generic entry, only pomalidomide had an active ingredient patent, which expired 12 months before the last expiring REMS patent. Generic manufacturers challenged 10 lenalidomide, 10 pomalidomide, 7 sodium oxybate, and 14 thalidomide REMS patents, leading to invalidation of 6 sodium oxybate REMS patents and 2 REMS patents each for lenalidomide, pomalidomide, and thalidomide. Discussion | REMS patenting was observed for one-fifth of REMScovered small-molecule drugs and constituted one-third to three-fourths of their patent portfolios. Generic entry occurred after expiration of the last expiring REMS patent for lenalidomide but a decade beforehand for alvimopan. REMS patents for alvimopan were not subject to challenges, while most REMS patents for lenalidomide, pomalidomide, sodium oxybate, and thalidomide were, with a few invalidations. Thus, the association of REMS patents with delaying generic entry has been variable.Study limitations included not being able to evaluate biologics since they do not have the same system of listing their patents with the FDA. 5 REMS can also complicate generic entry in other ways, such as when negotiations are needed to set up shared REMS between brand-name and generic manufacturers. 6 Since some REMS patents may contribute to delays in generic marketing for emerging REMS-covered drugs, to the detriment of patients and the health care system, Congress should consider shielding generic manufacturers from REMS patent infringement claims.

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„Resuscitative endovascular balloon occlusion of the aorta“ bei schwer verletzten Patienten im Schockraum: eine Fallserie

et al. 2022

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ZusammenfassungEine Hämorrhagie ist in 30–40 % der Patienten, die im Rahmen eines Traumas versterben, todesursächlich und die häufigste vermeidbare Todesursache. Für nichtkomprimierbare Blutungen im Bereich des Abdomens oder des Beckens wird in den letzten Jahren zunehmend (wieder) die Anwendung der „resuscitative endovascular balloon occlusion of the aorta“ (REBOA) zur temporären Blutungskontrolle diskutiert. Seit August 2020 steht im Schockraum des Universitären Notfallzentrums des Universitätsspital Bern die REBOA als Therapieoption im Rahmen der Schwerverletztenversorgung zur Verfügung. Wir berichten in dieser Fallserie unsere Erfahrungen aus allen 7 Anwendungen im Laufe des ersten Jahres.

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Computed tomography imaging of resuscitative endovascular balloon occlusion of the aorta (REBOA): pearls and pitfalls

Cited by 4 publications

References 16 publications

Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience

Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience

Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients With Exsanguinating Hemorrhage

„Resuscitative endovascular balloon occlusion of the aorta“ bei schwer verletzten Patienten im Schockraum: eine Fallserie

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