Use of an endovascular occlusion balloon for control of unremitting venous hemorrhage

Abstract

This report describes a new approach for management of iliac vein injury. These injuries are often difficult to expose, and the associated hemorrhage further hinders visualization and subsequent repair. In this case, the use of an endovascular balloon from groin access controlled venous hemorrhage and permitted a primary repair of a torn left iliac vein. We believe that this approach is unique in that it uses a compliant, low-pressure balloon, thus preventing further iatrogenic injury in otherwise fragile venous structures and allowing direct access to the tear when exposure in the operative field is limited.

Spontaneous left iliac vein rupture — case report

“…Particularly, at the location of the iliac vein, the right iliac artery, can obscure adequate exposure of the venous injury. Also, attempts to gain vascular control by the passage of clamps posterior to a vein can be hazardous, thus risking further injury [9]. Most issues related to the repair of venous injuries pertain to exposure in a haemorrhagic operative field.…”

“…Endovascular balloons, in contrast, can be passed intravascularly from a remote location, such as the groin vessels, when the vascular injury site itself may not be visible. Of note, in this scenario, a cut-down of femoral vessels was necessarily performed, given the subsequent aortobifemoral repair, but we expect that this approach would be equally useful through a percutaneous approach [9]. Haemodynamic stability was the key criterion.…”

Management of penetrating abdominal vessel injuries

“…Vascular control can be obtained by vascular tapes, vascular clamps, bull-dog clamps or balloon catheters passed into the vascular lesion, depending on the caliber of the injured vessel, the availability of specialized surgical skills, and the rapidity and habits of the attending surgeon. Venous wounds usually are unrelenting and finding the origin is sometimes difficult, even impossible [4,31]. Controlling the vessel above and below the lesion is useful in this setting.…”

Prise en charge des lésions vasculaires lors de traumatismes pénétrants de l’abdomen. Plaies vasculaires de l’abdomen

“…Une contamination générée par des lésions génito-urinaires et/ou coliques est la règle [2,4]. En péri-ou peropératoire, les techniques d'hémostase endovasculaire évitent des dissections traumatiques et des hémorragies cataclysmiques [4,31]. Un tamponnement par des champs tassés dans la cavité pelvienne est le geste le plus sûr ; l'abord des plaies vasculaires pelviennes doit être prudemment pesé.…”

“…Les plaies veineuses inondent en continu le champ opératoire et trouver la lésion peut être difficile, voire impossible[4,31]. Les contrôles d'amont et d'aval sont alors utiles.…”