External iliac artery dissection associated with resuscitative endovascular balloon occlusion of the aorta (REBOA) removal: a case report

Abstract

Introduction and importance: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used as an initial treatment for hemorrhagic shock. Case presentation: The patient was a man in his 70s with a history of alcohol use. He was brought to the hospital with high-energy trauma and hemorrhagic shock. REBOA was performed for a pubic-ischial fracture with pelvic contrast extravasation. Arterial embolization was performed using an interventional radiology, and partial occlusion was achieved. On the second day of hospitalization, the patient’s general condition improved, and the REBOA was removed with the stylet wire left in place. On the third day of hospitalization, contrast-enhanced computed tomography (CT) showed an antegrade dissection of the external iliac artery on the REBOA insertion side. No worsening of the dissected cavity was observed after conservative treatment. Clinical discussion: Previous reports have described vascular damage due to blind REBOA insertion and ischemic injury to lower-body organs due to prolonged occlusion. In this case, CT performed at the time of insertion did not reveal an external iliac artery dissection; therefore, it was suspected that the dissection occurred during insertion of the stylet wire for REBOA removal. Conclusion: This case suggests that serious vascular complications may be associated with REBOA, including during the period after device removal, and that careful procedures are required.