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. 2025 Aug 1;99(3S Suppl 1):S11-S19.
doi: 10.1097/TA.0000000000004689. Epub 2025 Jun 30.

Morphometric analysis for resuscitative endovascular balloon occlusion of the aorta in women

Rachel M Russo  1 , Brian A Derstine, Jarom Ruby, Sven Holcombe, Jonathan L Eliason, Stewart C Wang
Affiliations

Morphometric analysis for resuscitative endovascular balloon occlusion of the aorta in women

Rachel M Russo et al. J Trauma Acute Care Surg. .

Abstract

Background: The Joint Trauma System (JTS)'s resuscitative endovascular balloon occlusion of the aorta (REBOA) positioning guidance is derived from a predominantly male patient population. We aimed to validate these measurements in women.

Methods: Aortic computed tomography scans of 404 women from a trauma patient data set were analyzed. The aorta was divided into anatomic zones based on REBOA literature, with zone 3 subdivided at the inferior mesenteric artery for pelvic surgery. Balloon placement analysis identified the frequency of out-of-zone placement errors for recommended insertion depths (46 cm for zone 1, 28 cm for zone 3) and determined optimal insertion depths to minimize these errors in women.

Results: A 46-cm insertion depth reliably positioned the balloon in zone 1 99.3% of the time, while a 28-cm depth placed the balloon entirely in zone 3 65% of the time (64.3% left, 66.6% right). There were notable malpositioning rates, with balloons extending above the lowest renal artery (20.4%) or below the aortic bifurcation (13.6%). Balloon malposition was most frequent at extreme heights and weights. Adjusting balloon insertion depth to 48 cm improved zone 1 positioning (100%), while adjusting zone 3 positioning to account for differences in weight significantly reduced malpositioning errors. Zone 3b was commonly shorter than the 4-cm balloon, resulting in high rates of the balloon extending above or below the target zone.

Conclusion: Fixed-length REBOA balloon placement can be performed in women with a low rate of malpositioning in zones 1 and 3. Adjusting for weight can further reduce the frequency of malpositioning when targeting zone 3. Restricting the target zone to below the inferior mesenteric artery may benefit from adjusting for weight or using image guidance.

Level of evidence: Diagnostic Test or Criteria; Level III.

Keywords: Bleeding; endovascular procedures; uterine hemorrhage; women; wounds and injuries.

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