REBOA Improves Outcomes in Hybrid Surgery for Ruptured Abdominal Aortic Aneurysms

Abstract

Despite advancements in diagnostic methods and emergency interventions, mortality rates of ruptured abdominal aortic aneurysm (rAAA) continue to remain high. To address this issue, the resuscitative endovascular balloon occlusion of the aorta (REBOA) technique has been designed to provide temporary control of bleeding. We aimed to compare the impact of the REBOA technique during open aortic surgery for rAAA. Between January 2014 and November 2021, 53 consecutive patients (46 males, 7 females; mean age 71.9±7.9years; range 51-89years) who underwent emergency open aortic surgery for rAAA were retrospectively analyzed. Patients were divided into REBOA (21 patients) and non-REBOA (32 patients) groups. The primary outcomes were postoperative 24-hr and 30-day mortality. The secondary outcomes were intensive care unit (ICU) stay, in-hospital stay, bleeding, postoperative renal failure, bowel ischemia, and transient ischemic attack (TIA)/stroke rate. The REBOA group showed a significant reduction in mortality rates at both 24hr (9.5% vs. 37.5%, P=0.029) and 30days (14.2% vs. 43.7%, P=0.035) compared to the non-REBOA group. In-hospital stay (12.8±3.48 vs. 15.6±4.74days, P=0.02) and ICU stay (2.42±2.08 vs. 5.09±5.79days, P=0.048) were shorter among the REBOA group. Total procedure time and bleeding were reduced among the REBOA group without significant differences in terms of postoperative renal failure, bowel ischemia, and TIA/stroke rate. The REBOA group demonstrated significantly improved survival rates compared to the non-REBOA group, without a significant difference in complication rates. REBOA is considered a less invasive option compared to the traditional method for open aortic cross-clamping. This study demonstrated that the use of REBOA may be considered as a first-line treatment option for open surgery in cases of rAAA particularly when an off-the-shelf endovascular aneurysm repair device is not suitable.