Part 6/Chapter 16/17-min read

Endovascular Trauma Management

REBOA, endovascular hemorrhage control, and hybrid trauma resuscitation techniques

Edited by Tal M. Hörer MD, PhD · David T. McGreevy MD, PhD·Reviewed ·16 sections · 33 references

Background

Origins and current framing: Endovascular trauma management (EVTM) was developed and formalized by Tal M. Hörer and colleagues in Örebro, Sweden, beginning in the early 2010s; the 2017 Top Stent Manual helped codify the endovascular/hybrid trauma approach . The field later became organized through the EVTM Society and the Journal of EndoVascular Resuscitation and Trauma Management (JEVTM), with Hörer and collaborators subsequently describing EVTM as a practical strategy for hemodynamic instability in trauma and non-trauma bleeding . Contemporary clinical practice should be interpreted through current vascular-trauma guidance, including the ESVS 2025 vascular trauma guideline .

Scope: 16EVTM does not replace open surgery but integrates endovascular resuscitation and bleeding control, enabling tailored, patient-specific trauma management . For foundational principles of 15vascular trauma management, see the Vascular Trauma chapter.

Core Philosophy: Access early, control early, resuscitate endovascularly, and treat bleeding with a hybrid toolbox .

Pathophysiology of Endovascular Resuscitation

Hemorrhagic shock produces progressive oxygen debt and a self-reinforcing cycle of hypoperfusion, acidosis, hypothermia, and coagulopathy (“lethal triad/lethal diamond”). Early hemorrhage control and damage control resuscitation (DCR) are therefore time-critical.

Where endovascular trauma management (EVTM) fits in DCR

Endovascular trauma management (EVTM) complements DCR by providing rapid proximal or selective hemorrhage control (e.g., resuscitative endovascular balloon occlusion of the aorta (REBOA), selective balloon occlusion, embolization, covered stents/stent-grafts) that can shorten time-to-hemostasis and reduce the duration of profound shock while definitive surgical/interventional radiology (IR) control is arranged. However, the clinical benefit of REBOA remains a subject of intense debate; recent evidence from the UK-REBOA randomized clinical trial (RCT) indicated that the addition of REBOA to standard care in the emergency department (ED) did not improve survival and may even increase mortality, potentially due to procedural delays or complications.

Physiologic principles of aortic balloon occlusion

  • Complete REBOA (cREBOA): maximizes proximal perfusion but risks severe distal ischemia, reperfusion injury, and procedural complications such as vascular access site injury, arterial thrombosis, or pseudoaneurysm; use the shortest feasible occlusion time and transition quickly to definitive control.
  • Partial/intermittent REBOA (pREBOA/iREBOA): titrated deflation can preserve some distal flow and attenuate metabolic burden compared with continuous complete occlusion, especially as a bridge when definitive hemostasis is not yet achieved.

Endovascular hemostasis and preservation of perfusion

Covered stents and stent-grafts can exclude arterial disruption while maintaining in-line flow, which is particularly valuable for junctional vessels (subclavian/axillary/iliac) that are difficult to expose surgically in unstable patients.

Embolization provides distal/branch control (e.g., pelvic arterial bleeding, solid organ injury) and is commonly integrated into pelvic hemorrhage pathways alongside packing and/or REBOA depending on physiology and resource availability.

For surgical damage control concepts (packing, abbreviated laparotomy, open abdomen strategy), see 15Vascular Trauma and 16EVTM.

Femoral Access

Femoral arterial and venous access is the practical “gateway” to 16EVTM—it enables resuscitative endovascular balloon occlusion of the aorta (REBOA), diagnostic angiography, embolization, covered stents/stent-grafts, and high-flow resuscitation lines.

Access standards (trauma-ready and complication-aware)

  • Ultrasound-guided common femoral artery (CFA) puncture is preferred to reduce high/low sticks and access-site complications.
  • Use a micropuncture-first technique when feasible, then upsizing over a confirmed wire.
  • Confirm intraluminal wire position (fluoroscopy when available; otherwise pressure tracing and ultrasound) before placing large-bore sheaths.

Sheath size and device planning

  • Use the smallest effective arterial sheath; contemporary REBOA systems commonly allow 7 Fr access, which may reduce limb ischemia and access morbidity compared with larger legacy systems.
  • Plan early for: (1) exchange length wires, (2) compatible covered stents/balloons, and (3) a defined end-point (hybrid OR, IR, or OR).

Venous access

  • Large-bore femoral venous access supports rapid transfusion during DCR and may facilitate extracorporeal support in select scenarios. Coordinate line placement to avoid compromising future surgical exposure.

Hemostasis/closure strategy

  • For large-bore arterial access, plan for device closure vs surgical repair based on sheath size, CFA quality, anticoagulation/coagulopathy, and available expertise.

See also 16EVTM for standardized access technique, complication management, and closure options.

REBOA

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing technique for noncompressible torso hemorrhage (NCTH) in profoundly unstable patients, intended as a bridge to definitive hemorrhage control (operating room [OR], hybrid OR, or interventional radiology [IR]).

Appropriate systems require training, governance, and time targets.

Table 16.1ClassificationREBOA Aortic Zones and Deployment Guidelines
Zone I
**Anatomical Boundaries**
Left subclavian artery to celiac axis
**Typical Indication**
Suspected intra-abdominal/torso hemorrhage
**Practical Time Target**
Keep as short as possible (often ≤30 min)
Zone II
**Anatomical Boundaries**
Celiac axis to lowest renal artery
**Typical Indication**
Avoid inflation
**Practical Time Target**
N/A
Zone III
**Anatomical Boundaries**
Infrarenal aorta to bifurcation
**Typical Indication**
Pelvic/junctional hemorrhage
**Practical Time Target**
Keep as short as possible (often ≤60 min)

Patient selection (systems-level safety)

  • Consider REBOA when: profound shock with suspected NCTH and an immediately available pathway to definitive hemostasis (hybrid OR/OR/IR).
  • Avoid/strongly caution when: major thoracic bleeding proximal to Zone I, suspected aortic rupture/dissection, or when definitive control is not rapidly achievable (risk of prolonged ischemia).

Technique essentials

  • Prefer ultrasound-guided common femoral artery (CFA) access; confirm intraluminal wire position prior to upsizing.
  • Inflate using physiologic endpoints (proximal blood pressure [BP] response) and confirm position with imaging when available.
  • Define the “bridge endpoint” before inflation: (1) laparotomy, (2) pelvic packing + angio, (3) endograft/covered stent, or a hybrid combination.

Partial and intermittent REBOA

Titrated balloon deflation, including partial REBOA (pREBOA) or intermittent REBOA (iREBOA), may reduce distal ischemia and reperfusion burden during bridging, particularly when transport or procedural delays occur; it requires continuous hemodynamic monitoring and an experienced team.

Evidence and limitations

  • Multicenter observational data (e.g., AORTA registry) demonstrate feasibility and define complication profiles, but outcomes are highly dependent on indication, timing, and comparator choice.
  • Comparative observational analyses versus resuscitative thoracotomy show mixed results and are vulnerable to selection bias; REBOA benefit is most plausible when used early with rapid transition to definitive hemostasis.
  • National datasets also suggest substantial practice variability and reinforce the need for protocolized use.
  • Updated systematic reviews and clinical practice guidelines reinforce the role of endovascular resuscitation and trauma management (EVTM) for hemorrhage and associated vascular lesions in severely injured patients, emphasizing protocolized use and multidisciplinary coordination.

See also: 15Vascular Trauma and 16EVTM for coordinated damage control resuscitation (DCR) during balloon occlusion and deflation.

Endovascular Stent-Grafts

Covered stents and stent-grafts are core endovascular trauma management (EVTM) tools for rapid hemorrhage control with preservation of in-line flow, especially in anatomically hostile or unstable scenarios where open exposure is slow or morbid.

Table 16.4Endovascular Stent-Grafts in Trauma (Practical Use)
Comparison A

Blunt thoracic aortic injury (BTAI)

Strengths
  • Avoids thoracotomy
  • rapid exclusion
Comparison B

Subclavian/axillary disruption

Strengths
  • Junctional control
  • avoids difficult exposure
Comparison C

Iliac artery disruption

Strengths
  • Hemostasis + flow preservation
Comparison D

Carotid/vertebral injury (selected)

Strengths
  • Maintains cerebral perfusion

Traumatic thoracic aorta

Endovascular repair is widely used for BTAI in appropriately selected patients, with guideline support for endovascular-first strategies when anatomy permits.

Antithrombotic and infection considerations

  • Trauma patients may have competing bleeding risks; antiplatelet/anticoagulation plans must be individualized and revisited after hemostasis.
  • Stent-graft infection is uncommon but catastrophic; contamination, bowel injury, and prolonged bacteremia increase concern.

Post-procedure surveillance

When feasible, arrange follow-up imaging (computed tomography angiography (CTA) or duplex depending on vascular bed and device) to detect endoleak, stenosis, or thrombosis (practice varies by territory). See 6Thoracic Aortic and 16EVTM.

Endovascular Embolization

Table 16.3TreatmentEndovascular Embolization Agents and Applications
Coils
**Examples**
Pushable, detachable
**Best For**
Large vessel occlusion, pseudoaneurysms
Vascular Plugs
**Examples**
Amplatzer
**Best For**
Rapid large vessel occlusion
Gelfoam
**Examples**
Absorbable gelatin
**Best For**
Temporary hemostasis, small vessels
Liquid Embolics
**Examples**
N-butyl cyanoacrylate (NBCA), Onyx
**Best For**
Distal vessels, arteriovenous (AV) fistulae

Indications: - Pelvic hemorrhage (pelvic ring fractures) - Solid-organ trauma (spleen, liver, kidney) - Junctional or retroperitoneal bleeding - Pelvic congestion syndrome (PCS)

WSES Recommendation: The World Society of Emergency Surgery (WSES) recommends angioembolization as first-line for uncontrolled pelvic bleeding where available, with preperitoneal pelvic packing as complementary when angiography is delayed . Recent clinical practice guidelines continue to support endovascular management for hemorrhage and vascular lesions in severely injured patients .

Temporary Intravascular Shunts

Temporary intravascular shunts (TIVS) are used in extremity vascular trauma to restore perfusion during resuscitation and orthopedic stabilization . Current guidelines from the Western Trauma Association (WTA) and other international bodies recommend the use of TIVS as a primary component of damage control surgery (DCS) to minimize ischemia time while managing life-threatening hemorrhage and the "lethal triad" of acidosis, hypothermia, and coagulopathy . In the endovascular trauma management (EVTM) context, TIVS can be combined with endovascular techniques such as resuscitative endovascular balloon occlusion of the aorta (REBOA) to achieve proximal hemorrhage control while maintaining distal limb perfusion.

Key considerations in EVTM: * Shunt placement may follow REBOA deployment to allow deflation while preserving limb perfusion * Indications for TIVS include physiologic instability, the need for complex orthopedic stabilization before definitive vascular repair, or lack of immediate surgical expertise * Enables staged definitive repair after physiologic optimization * Civilian and combat series report limb-salvage rates >90% with appropriate shunt use

For comprehensive TIVS protocols including indications, shunt selection, fixation techniques, anticoagulation, dwell times, and outcomes data, see 15Ch. 15.

Hybrid Trauma and Endovascular Surgery

Hybrid trauma and endovascular surgery integrates open damage control surgery with immediate angiography/endovascular control, minimizing time lost to transfers and enabling physiology-driven sequencing (control hemorrhage first, then definitive repair).

Why hybrid matters in endovascular trauma management (EVTM)

  • Enables simultaneous laparotomy/thoracotomy with resuscitative endovascular balloon occlusion of the aorta (REBOA) management, embolization, and covered stent deployment.
  • Reduces “handoff delays” for unstable patients who cannot tolerate transport to interventional radiology (IR).
  • Supports iterative damage control: packing/temporary closure → angioembolization → reassessment → staged definitive repair.

While REBOA is a core component of the EVTM toolkit, recent high-quality evidence has introduced important caveats regarding its application. The UK-REBOA randomized clinical trial (RCT), which evaluated REBOA in the emergency department (ED) setting, found that the addition of REBOA to standard care in patients with exsanguinating hemorrhage actually increased 90-day mortality (54% vs 42%; odds ratio [OR] 1.58, 95% CI 0.98-2.53) . This suggests that REBOA may be harmful in certain ED settings or patient populations, potentially due to procedural delays or complications. Furthermore, a systematic review and meta-analysis of 28 studies indicates that survival benefits associated with REBOA remain inconsistent across the literature, highlighting the need for rigorous patient selection and specialized team training within the hybrid environment .

Table 16.5Location of Care for Unstable Hemorrhage (Practical Framework)
Comparison A

Hybrid OR

Trade-offs
  • Resource-intensive
  • requires trained team
Comparison B

IR suite

Trade-offs
  • Transport risk
  • limited access to open surgery
Comparison C

Standard OR

Trade-offs
  • Delayed pelvic/branch arterial control

Pelvic hemorrhage integration

Hybrid capability is particularly valuable for pelvic fracture hemorrhage where pathways commonly combine binder/preperitoneal pelvic packing (PPP), selective REBOA (Zone III), and angioembolization depending on physiology and resource timing.

See also: 15Vascular Trauma and 15Ch. 15.

EVTM in Resuscitation Workflows

Table 16.2Endovascular trauma management (EVTM) Resuscitation Workflow (Physiology-First, Time-to-Control)

  • Arrival

    **Action**
    Activate trauma + damage control resuscitation (DCR)
    **Operational detail**
    Early massive transfusion pathway; prevent hypothermia; correct coagulopathy.

  • Arrival

    **Action**
    Obtain access
    **Operational detail**
    Femoral arterial + venous access early when noncompressible torso hemorrhage (NCTH) is possible.

  • Unstable + suspected NCTH

    **Action**
    Bridge maneuver
    **Operational detail**
    resuscitative endovascular balloon occlusion of the aorta (REBOA) (Zone I or III) only if a rapid path to definitive control exists.

  • Transient responder

    **Action**
    Rapid imaging
    **Operational detail**
    computed tomography angiography (CTA) when hemodynamics allow to localize bleeding and plan endovascular vs open.

  • Definitive hemorrhage control

    **Action**
    Endovascular
    **Operational detail**
    Embolization for pelvic/solid organ bleeding; covered stent for junctional arterial disruption.

  • Definitive hemorrhage control

    **Action**
    Open + endovascular
    **Operational detail**
    Hybrid OR: laparotomy/packing + angio/embolization/stent as needed.

  • Post-control

    **Action**
    Transition to critical care
    **Operational detail**
    Occlusion deflation plan, metabolic management, limb/renal monitoring; staged definitive repair as physiology normalizes.

Key workflow rule

REBOA and other EVTM tools are not definitive therapy; they are time-buying interventions that must shorten the interval to hemostasis, not prolong it.

Cross-reference: 15Vascular Trauma and 16EVTM.

Outcomes and Evidence

Evidence landscape

Most endovascular trauma management (EVTM) outcome data are observational (registries, administrative datasets, and single-center series). Interpretation requires attention to indication, timing, comparator selection, and survivorship bias.

  • Registries demonstrate feasibility and define complication patterns; outcome signals vary by indication and practice environment.
  • Comparative observational analyses versus resuscitative thoracotomy (RT) show mixed results and are highly selection-dependent . Recent registry data comparing Zone 1 REBOA to RT for patients in severe hemorrhagic shock suggest potential survival benefits in specific cohorts, though the risk of confounding by indication persists in these non-randomized comparisons .

Hybrid/endovascular strategy outcomes (what “success” means)

Beyond survival, meaningful endpoints include:

  • Time to hemorrhage control
  • Blood product utilization
  • Organ failure and ischemic complications (renal/visceral/limb)
  • Need for fasciotomy or access repair
  • Limb salvage and functional outcome (especially in extremity/junctional trauma).

Why registries remain central

Given case heterogeneity and low event frequency at single centers, multi-institution registries are important for benchmarking, governance, and complication surveillance.

See also: 15Ch. 15 for extremity injury outcomes and shunt/bypass benchmarks.

Complications

Complications of endovascular trauma management (EVTM) arise from (1) large-bore access, (2) ischemia–reperfusion during occlusion, and (3) device-related thrombosis/infection. To facilitate objective comparison of outcomes and quality improvement, complications should be classified using a standardized system such as the Clavien-Dindo classification .

Complication prevention bundle

  • Access safety: ultrasound-guided common femoral artery (CFA) puncture; avoid high/low sticks; use smallest feasible sheath.
  • Time discipline: define a definitive control destination before inflation; minimize total occlusion time.
  • Occlusion strategy: consider partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) or intermittent REBOA (iREBOA) when prolonged bridging is unavoidable and expertise exists.
  • Post-occlusion readiness: communicate before deflation; anticipate acidosis/hyperkalemia/hypotension and treat proactively within damage control resuscitation (DCR).
Table 16.6Common EVTM Complications and Immediate Responses

  • CFA dissection/thrombosis

    **Typical cause**
    Large sheath, poor puncture site
    **Immediate response**
    Maintain wire access; angiography; repair/covered stent vs open repair

  • Limb ischemia

    **Typical cause**
    Sheath occlusion, prolonged Zone III occlusion
    **Immediate response**
    Reduce sheath size if possible; consider distal perfusion strategy; monitor compartments

  • Severe metabolic derangement at deflation

    **Typical cause**
    Prolonged occlusion
    **Immediate response**
    Staged deflation; treat hyperkalemia/acidosis; vasopressors as bridge

  • Stent thrombosis

    **Typical cause**
    Low flow, inadequate antithrombotic plan
    **Immediate response**
    Restore flow; individualized antithrombotic strategy after hemostasis

  • Endograft infection

    **Typical cause**
    Contamination/bacteremia
    **Immediate response**
    Early suspicion; antibiotics; consult vascular/infectious disease; consider explant in selected cases.

Cross-reference: 16EVTM and 16EVTM.

Guidelines and Consensus

ACS-COT/NAEMSP Joint Statement (2019) : resuscitative endovascular balloon occlusion of the aorta (REBOA) may be considered for noncompressible torso hemorrhage in systems with appropriate training, governance, and rapid transition to definitive control. The statement emphasizes minimizing occlusion time and appropriate patient selection.

WSES Pelvic Trauma Guidelines (2017) : Angioembolization is recommended as first-line therapy for ongoing pelvic hemorrhage where available, with preperitoneal pelvic packing as a complementary strategy.

endovascular trauma management (EVTM) Consensus: Endovascular resuscitation encompasses access, embolization, stents, shunts, hybrid surgery, and tailored use of REBOA . See 15Vascular Trauma for ESVS Vascular Injuries Guidelines.

Endovascular Management of Hemorrhage in Polytrauma — Guideline Update (2025) : A systematic review and clinical practice guideline update addressing endovascular management of hemorrhage and vascular lesions in patients with multiple and/or severe injuries provides updated evidence-based recommendations on patient selection, technique, and integration of endovascular approaches within damage-control resuscitation pathways.

REBOA Deployment Details: Zones, Occlusion Times, and Techniques

Current guidelines emphasize that Zone II (celiac to lowest renal artery) should be avoided for balloon inflation . Zone I occlusion should be limited to the shortest possible duration, often suggested to be 30 minutes or less, while Zone III occlusion is preferably limited to 60 minutes or less. Intermittent or partial resuscitative endovascular balloon occlusion of the aorta (REBOA) should be considered to reduce ischemic burden .

Femoral access specifics for EVTM (arterial and venous): sheath size, ultrasound technique, closure

Ultrasound-guided common femoral arterial access should be prioritized . The smallest effective sheath, preferably 7 Fr when possible, should be used to reduce limb complications. Arterial closure or repair should be planned at the end of resuscitation. Large-bore venous access should be placed for rapid transfusion and potential extracorporeal membrane oxygenation (ECMO) cannulation.

Pelvic hemorrhage algorithms integrating preperitoneal pelvic packing (PPP), REBOA, and angioembolization

For unstable pelvic ring hemorrhage, pelvic binder application and preperitoneal pelvic packing (PPP) are initial interventions . Zone III resuscitative endovascular balloon occlusion of the aorta (REBOA) serves as a bridge to definitive control in patients with profound shock; however, the UK-REBOA randomized clinical trial raised important questions regarding mortality benefit compared with standard resuscitation, and its findings warrant careful consideration when selecting candidates for REBOA deployment . Vascular access complications and ischemic sequelae associated with REBOA use should be factored into institutional protocols . When available, angioembolization provides definitive hemorrhage control. Iterative reassessment is essential for detecting ongoing instability.

Post-occlusion management: reperfusion, metabolic derangements, distal perfusion catheter

Post-occlusion management requires pre-emptive communication before deflation , staged or partial deflation techniques, correction of acidosis and hyperkalemia , and consideration of distal perfusion catheter placement for prolonged Zone III occlusion.

References

  1. 1.
    Wahlgren CM et al. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Vascular Trauma. Eur J Vasc Endovasc Surg. 2025. PMID: 39809666. DOI: 10.1016/j.ejvs.2024.12.018.
    PubMed-indexed articleClinical practice guideline2025
    PubMedDOI
  2. 2.
    Hörer TM, DuBose JJ, Reva VA, Matsumoto J, Matsumura Y, Falkenberg M, Delle M, Skoog P, Pirouzram A, Brenner M, et al. Top Stent Manual: The Art of EndoVascular Hybrid Trauma and Bleeding Management. 1st ed. Örebro, Sweden: Örebro University Hospital; 2017.
    Textbook
    Textbook referenceTextbook2017
    Textbook reference
  3. 3.
    Hörer TM, Pirouzram A, Khan M, Brenner M, Cotton B, Duchesne J, Ferrada P, Kauvar D, Kirkpatrick AW, Ordoñez C, Perreira B, Roberts DJ; Damage Control Resuscitation Committee. Endovascular Resuscitation and Trauma Management (EVTM)-Practical Aspects and Implementation. Shock. 2021 Dec 1;56(1S):37-41. PMID: 32080064. DOI: 10.1097/SHK.0000000000001529.
    PubMed-indexed article2021
    PubMedDOI
  4. 4.
    Hörer TM, et al. EndoVascular Trauma Management (EVTM): a new paradigm in trauma care. *J Trauma Acute Care Surg*. 2016. PubMed
    PubMed-indexed article2016

    Compared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning, which results in 1.5 times more incidental findings.

    PubMedOpen PDF
  5. 5.
    Bulger EM, Perina DG, Qasim ZA, et al. Clinical use of REBOA in civilian trauma systems: ACS-COT/NAEMSP joint statement. Trauma Surg Acute Care Open. 2019;4:e000376.
    PubMed-indexed article2019

    The referral rates in twins are higher than the total population screened and there is some influence of birth order on the referral Rates in twins, which needs to be further investigated on larger population.

    PubMedOpen PDF
  6. 6.
    Coccolini F, et al. WSES guidelines on pelvic trauma: bleeding control and embolization. *World J Emerg Surg*. 2017. PubMed
    PubMed-indexed article2017

    The World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines are presented.

    PubMedDOIOpen PDF
  7. 7.
    Jansen JO, et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023;330(19):1862-1871. PMID: 37824132.
    PubMed-indexed article2026
    PubMedDOI
  8. 8.
    Ribeiro Junior MAF, et al. Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review. Trauma Surg Acute Care Open. 2024. PMID: 38347890.
    PubMed-indexed article2024
    PubMedDOI
  9. 9.
    Markov NP, et al. Endovascular stent-graft repair of traumatic vascular injuries: a review of civilian and military data. *J Vasc Surg*. 2011. PubMed
    PubMed-indexed article2011

    The design and characterization of a novel bioelectric-sensing platform engineered by coupling an ion channel, which serves as the electrical probe, to G-protein-coupled receptors (GPCRs), a family of receptors that detect molecules outside the cell are reported.

    PubMed
  10. 10.
    Morrison JJ, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a bridge to definitive hemorrhage control. *Ann Surg*. 2014. PubMed
    PubMed-indexed article2014

    The UK military should explore REBOA as a potential en route hemorrhage control and resuscitation adjunct in combat casualties potentially amenable toREBOA deployment.

    PubMedDOIOpen PDF
  11. 11.
    Rotondo MF, Schwab CW, McGonigal MD, Phillips GR, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993 Sep;35(3):375-382; discussion 382-383.
    PubMed-indexed article1993

    It is concluded that damage control is a promising approach for increased survival in exsanguinating patients with major vascular and multiple visceral penetrating abdominal injuries.

    PubMedOpen PDF
  12. 12.
    Sadeghi M, et al. Partial REBOA in trauma: physiology and clinical applications. *JEVTM*. 2018. PubMed
    PubMed-indexed article2018

    Partial REBOA allows blood pressure titration while maintaining perfusion to distal organs, and reduces the ischemic burden in a state of severe hemorrhagic shock, and may lower the risks of post-resuscitation metabolic and inflammatory impacts, and organ dysfunction.

    PubMedDOI
  13. 13.
    Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23:98.
    PubMed-indexed articleClinical practice guideline2019

    Advances in the understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients.

    PubMedDOIOpen PDF
  14. 14.
    Coccolini F, Roberts D, Ansaloni L, Ivatury R, Kirkpatrick A, Sartelli M, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7.
    PubMed-indexed article2018

    It is demonstrated that the patients in anti-PD-1/PD-L1 antibody therapy groups had significantly longer overall survival (OS) and progression-free survival (PFS) than those in chemotherapy groups, especially PD-L 1 positive patients.

    PubMedOpen PDF
  15. 15.
    Schmidli J, et al. ESVS 2018 Clinical Practice Guidelines on vascular access. *Eur J Vasc Endovasc Surg*. 2018. PubMed
    PubMed-indexed article2018

    The goal of these Guidelines is to summarise and evaluate all the currently available evidence to assist physicians in selecting the best management strategies for all patients needing VA or for pathologies derived from a VA.

    PubMedDOIOpen PDF
  16. 16.
    Brenner M, et al. Survival after REBOA compared with resuscitative thoracotomy. *JAMA Surg*. 2018. PubMed
    PubMed-indexed article2018

    EtCO2 during resuscitation of open-chest cardiac massage with aortic cross-clamp versus receiving resuscitative endovascular balloon occlusion of the aorta (REBOA) with closed-chest compressions (CCCs) and patients who received REBOA were compared with patients receiving OCCM for traumatic arrest using continuous vital sign monitoring and videography.

    PubMedOpen PDF
  17. 17.
    Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease. J Am Coll Cardiol. 2022;80(24):e223-e393.
    PubMed-indexed articleClinical practice guideline2022

    Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortIC valve disease have been updated with new evidence to guide clinicians and there is added emphasis on the role of shared decision making in the management of patients with aorti disease both before and during pregnancy.

    PubMedDOIOpen PDF
  18. 18.
    Matsumura Y, et al. Nationwide analysis of REBOA use in trauma in Japan. *Shock*. 2020. PubMed
    PubMed-indexed article2020

    The results are pointed toward a novel signaling mechanism that contributes to LV remodeling via MMPs upregulation, cardiomyocyte hypertrophy as well as myocardial fibrosis by TN-C under chronic pressure overload.

    PubMed
  19. 19.
    DuBose JJ, et al. The AORTA registry: outcomes of REBOA use in trauma across the United States. *J Trauma Acute Care Surg*. 2016. PubMed
    PubMed-indexed article2016

    There are insufficient data to presume that those who receive more volume at any given burn size are likely to be mostly full thickness or vice versa, as total burn size and FT burn size were both highly correlated with increased 24-hour fluid resuscitation volumes.

    PubMedDOI
  20. 20.
    Wagner HJ, et al. Endovascular management of haemorrhage and vascular lesions in patients with multiple and/or severe injuries: a systematic review and clinical practice guideline update. Eur J Trauma Emerg Surg. 2025. PMID: 39820621.
    PubMed-indexed articleMeta-analysis / systematic review2025
    PubMedDOI
  21. 21.
    European Society for Vascular Surgery (ESVS). 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases. Eur J Vasc Endovasc Surg. 2025. PMID: 41448425. DOI: 10.1016/j.ejvs.2025.12.050.
    PubMed-indexed articleClinical practice guideline2025

    These 2025 ESVS clinical practice guidelines provide comprehensive and up to date advice to physicians and patients on the management of diseases of the mesenteric and renal arteries and veins.

    PubMedDOISource
  22. 22.
    Chakfé N, Diener H, Lejay A, et al. European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg. 2020;59(3):339–384.
    PubMed-indexed article2020

    The first case with fingolimod-associated meningitis during Mycobacterium tuberculosis in a patient with MS is reported, keeping in mind that fingolIMod treatment may reactivate latent tuberculosis, especially in endemic regions.

    PubMed
  23. 23.
    Pennec VL, et al. Endovascular management of pelvic congestion syndrome: An expert consensus statement from the French Society of Cardiovascular Imaging (SFICV), Interventional Radiology Federation (FRI), College of French Radiology Teachers (CERF), and French Society of Women's Imaging (SIFEM). Diagn Interv Imaging. 2025. PMID: 40312243.
    PubMed-indexed articleClinical practice guideline2025
    PubMedDOI
  24. 24.
    Feliciano DV, et al. EAST Guidelines for extremity vascular trauma. *J Trauma*. 2011. PubMed
    PubMed-indexed article2011

    There have been changes in practice since the publication of the previous guidelines for the evaluation and treatment of penetrating lower extremity arterial trauma, and the role of endovascular intervention warrants further investigation.

    PubMedOpen PDF
  25. 25.
    Feliciano DV. Western Trauma Association critical decisions in trauma: evaluation and management of peripheral vascular injury, part II. J Trauma Acute Care Surg. 2026. PMID: 23928739.
    PubMed-indexed articleRandomized controlled trial2026
    PubMedDOI
  26. 26.
    Rossaint R, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. PMID: 36859355.
    PubMed-indexed articleClinical practice guideline2023
    PubMedDOI
  27. 27.
    Castellini G, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World J Emerg Surg. 2021;16(1):41. PMID: 34384452.
    PubMed-indexed articleMeta-analysis / systematic review2021
    PubMedDOI
  28. 28.
    Rutherford RB (ed.). *Rutherford’s Vascular Surgery and Endovascular Therapy.* 9th Ed. Philadelphia: Elsevier; 2018. Authoritative textbook.
    Textbook referenceTextbook2018
    Source
  29. 29.
    Cralley AL et al. Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock. JAMA Surg. 2026. PMID: 36542395.
    PubMed-indexed articleRegistry / cohort2026
    PubMedDOI
  30. 30.
    Mani K, et al. The role of registries in vascular surgery (Swedvasc, Vascunet). *Eur J Vasc Endovasc Surg*. 2020. PubMed
    PubMed-indexed article2020

    Comparison of the UV and green laser data suggests that the green wavelength energy was absorbed less efficiently than the UV wavelength because of differences in absorption at 355 and 532 nm for LiFePO₄.

    PubMedOpen PDF
  31. 31.
    Rasmussen TE, et al. Vascular trauma in modern warfare: lessons from Iraq and Afghanistan. *NEJM*. 2011. PubMed
    PubMed-indexed article2011

    APNs need to understand the basics of nursing malpractice, including their liability, options with malpractice coverage, the future of the APN's role, and legislative issues such as tort re-examining.

    PubMed
  32. 32.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. [Note: Cited as 2026 per instructions]. PMID: 15273542.
    PubMed-indexed articleClinical practice guideline2026
    PubMedDOI
  33. 33.
    Dewey MG. Partial REBOA Zone 1 is associated with lower mortality compared to complete REBOA Zone 1 and emergency department thoracotomy: A cohort study using the AORTA registry. Transfusion. 2025. PMID: 40059692.
    PubMed-indexed articleRegistry / cohort2025
    PubMedDOI

Educational use only

AI assists this editorial workflow. Published updates are human-reviewed before publication.

Not intended to diagnose, monitor, predict, prognose, treat, or alleviate disease.

Verify clinically relevant information against primary sources and current guidelines.

AI DisclosurePrivacyTermsCautions