Outcomes and Evidence

in Endovascular Trauma Management

Applied

Type

Modification

Confidence

95%

Created

Mar 27, 2026

Evidence

2 sources

Rationale

The integration of the UK-REBOA trial (Jansen 2026) is critical as it represents the first major RCT in the field, significantly altering the 'Evidence landscape' which was previously purely observational. The Cralley 2026 registry data provides a more nuanced comparison between REBOA and RT, specifically highlighting the role of CPR status. Abbreviations (RT, CPR, RCT) were expanded on first use as per instructions.

Evidence

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.
Verified source
PubMedDOI
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. 2026. PMID: 37824132.
Verified source
PubMedDOI

Content Changes

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**Evidence landscape**

MostWhile most endovascular trauma management (EVTM) outcome data are **observational**observational (registries, administrative datasets, and single-center series).series), the evidence landscape has recently expanded to include randomized controlled trial (RCT) data [@jansen2026-g]. Interpretation requires attention to indication, timing, comparator selection, and survivorship bias. [@trauma2016-aorta] [@matsumura2020]

**resuscitative endovascular balloon occlusion of the aorta (REBOA) outcomes**

- Registries demonstrate feasibility and define complication patterns; outcome signals vary by indication and practice environment. [@trauma2016-aorta]
- Comparative observational analyses versus resuscitative thoracotomy (RT) show mixed results and are highly selection-dependent.selection-dependent [@brenner2018-survival][@brenner2018-survival]. Recent registry data suggest that Zone 1 REBOA may offer a survival benefit compared to RT in patients who do not require cardiopulmonary resuscitation (CPR) [@cralley2026-f].
- The UK-REBOA RCT found that the addition of REBOA to standard care in patients with exsanguinating hemorrhage resulted in higher mortality compared to standard care alone, emphasizing that the benefits of REBOA may be setting-specific and dependent on rapid definitive hemorrhage control [@jansen2026-g].

**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). [@rasmussen2011-vascular]

**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. [@mani2020]

See also: [[Vascular Trauma|Ch. 15]] for extremity injury outcomes and shunt/bypass benchmarks.
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