Successful use of resuscitative endovascular balloon occlusion of the aorta in the treatment of ruptured 8.5-cm splenic artery aneurysm

Abstract

Spontaneous rupture of splenic artery aneurysm is a rare cause of acute abdomen with hemorrhagic shock that is a life-threatening surgical emergency. We report a case of a spontaneous rupture of an 8.5-cm splenic artery aneurysm managed using resuscitative endovascular balloon occlusion of the aorta (ER-REBOA Catheter; Prytime Medical Inc, Boerne, Tex) for proximal control of the aorta before laparotomy. This is a minimally invasive technique that can be used as an adjunct to massive transfusion resuscitation and laparotomy for life-threatening intraperitoneal hemorrhage.

Indicações e resultados para o uso expandido da oclusão ressuscitativa por balão endovascular da aorta - REBOA.

“…We grouped the articles according to indication, into patients with non-traumatic abdominal hemorrhages, which were mostly case reports, the main indications being gastrointestinal bleeding, aneurism, iatrogenic bleeding and bleeding of unknown origin (Table 1) [16][17][18][19][20][21][22] . Another indication was for postpartum hemorrhage (Table 2) 20,23-28 .…”

“…Among the studies described, the main benefits of REBOA use were hemorrhage control and elevation of arterial pressure, reducing blood transfusion requirements and allowing patients to reach definitive treatment of injuries [16][17][18][19][20][22][23][24]26,27,29 . We carried out the analysis of this study in a segmented way, considering two large groups:…”

“…Greer et al 27 2018 Case report Placenta accrete. The other studies did not report mortalities 16,19,22 .…”

“…Currently, the use of REBOA in nontraumatic abdominal hemorrhages is principally based on case reports, with a lack of high level evidence in the literature for its indication in these settings 16,18,19,21,22 . Prospective studies should be carried out to clarify the role of REBOA in these cases 17,20 17 .…”

A review of management options for splenic artery aneurysms and pseudoaneurysms

“…Ologun et al mentioned that the pathogenesis of SAAs includes hypertension, hormonal factors (associated with degeneration of internal elastic lamina and elastin formation), hemodynamic changes (increased blood volume, cardiac output and portal congestion), and medial degeneration. Changes histologically include atherosclerotic changes, artery dysplasia, fibromuscular dysplasia, calcifications, cystic medial degeneration, and intimal hyperplasia [ 11 ]. Sadat et al describes that in pregnancy, hormones (oestrogen, progesterone and relaxin) and psychological changes affect the arterial wall, causing medial degeneration and stress on arterial wall that leads to aneurysmal dilatation [ 12 , 13 ].…”