Resuscitative Endovascular Balloon Occlusion of the Aorta for Blood Control in Lumbar Spine Tumor Resection Surgery: A Technical Note

Abstract

Objectives: To describe the technique of the aorta balloon occlusion, and evaluate the blood loss in lumbar spine tumor surgery assisted by aortic balloon occlusion, and to observe the balloon-related complications.

Methods: Six patients with lumbar spine tumor underwent resuscitative endovascular balloon occlusion of the aorta prior to tumor resections in our institution between May 2018 to January 2021. Medical records including demographic, diagnosis, tumor location, surgical approach, intraoperative blood loss, surgical duration, and perioperative balloon-related complication were evaluated retrospectively.

Results: This series included four males and two females, with a median age of 50 years (range 22 to 69). Of these, three primary tumors were plasmacytoma, giant cell tumor of bone, and osteosarcoma, while recurrence of undifferentiated pleomorphic sarcoma (UPS), recurrence of giant cell tumor of bone (GCT), and metastatic thyroid cancer were diagnosed in cases 1, 6, and 2, respectively. L₂ was involved in cases 1 and 5. L₃ was involved in case 6. L₄ was involved in case 2, 3, and 6. L₅ was involved in case 4. One-stage total en bloc resection surgery (TES) was accomplished in all patients; of this series, signal anterior approach was conducted in case 1, signal posterior approach was utilized in cases 2, 3, and 6, while combined anterior and posterior approach was performed in cases 4 and 5. The median intraoperative blood loss was 1683 mL and ranged from 400 to 3200 mL with a median surgical duration of 442 min and a range from 210 to 810 min. During the perioperative period, no serious balloon-related complications occurred.

Conclusions: Endovascular balloon occlusion of the aorta successfully controls intraoperative exsanguination, contributing to a more radical tumor resection and a low rate of tumor cell contamination in lumbar tumor surgery.

Keywords: Aortic occlusion; Balloon; Blood control; Hemorrhage; Lumbar spine.

Fig. 1

Schematic diagram of a patient with a tumor involved to level L₄ obtained resuscitative endovascular balloon occlusion of the aorta intraoperatively. (A) The patient was transferred to the interventional radiology unit and placed in supine position. Abiding by the Seldinger technique, a balloon dilation catheter (BDC) was inserted into the designated location and then shifted to prone position. (B) The expected position of the balloon was cephalad to abdominal aortic bifurcation but caudal to the renal arteries (zone III). After the balloon inflated, blood flow to the distal aorta was stopped during the subsequent tumor resection. (C) During orthopaedic oncology procedure, occlusion of abdominal aorta was identified by the disappearance of dorsal pedis arteries and pulse oximeter oxygen saturation (SpO₂) signals from toe.

Fig. 2

A 69‐year‐old male with lumbar spine tumor. (A, B) Preoperative magnetic resonance (MR) showed a low signal on T1‐weighted image and a high signal on T2‐weighted image in level L₄. (C) Preoperative DCE‐MRI was performed and the average time‐signal intensity curve depicted increased blood flow to the lesions. (D) Intraoperative fluoroscopy revealed the position of balloon catheter cephalad to L₄ vertebra and caudal to the renal arteries. (E, F) After tumor resection, spinal stability was reconstructed with pedicle screw‐rod system. (G, H) A plasmacytoma was diagnosed histologically by paraffin sections postoperatively.