Complications
Type
ReinforcementConfidence
62%
Created
Mar 27, 2026
Evidence
1 source
Rationale
The article (PMID 38347890) is a narrative review of REBOA complications, which is directly relevant to this section. However, the existing section already covers the key REBOA complication categories (access injury, limb ischemia, metabolic derangement) comprehensively in both the prevention bundle and the complications table. The article does not introduce new complication categories or contradict existing content. Given its relevance score of 40/100 and 'needs-human-review' recommendation, a light-touch integration is appropriate: a single reinforcing sentence was added after the table to acknowledge the updated evidence base without disrupting the existing structure, tone, or citation density. No structural changes, heading modifications, or table alterations were made. The REBOA abbreviation is expanded on first use in the new sentence per the abbreviation rules, though it is likely already expanded earlier in the chapter — the expansion is included here for section-level completeness. Confidence is moderate given the review-level evidence quality.
Evidence
Content Changes
<!-- type: complications --> Complications of endovascular trauma management (EVTM) arise from (1) large-bore access, (2) ischemia–reperfusion during occlusion, and (3) device-related thrombosis/infection. <!-- type: checklist --> **Complication prevention bundle** - **Access safety:** ultrasound-guided CFA puncture; avoid high/low sticks; use smallest feasible sheath. [@bulger2019] - **Time discipline:** define a definitive control destination before inflation; minimize total occlusion time. [@bulger2019] - **Occlusion strategy:** consider pREBOA/iREBOA when prolonged bridging is unavoidable and expertise exists. [@sadeghi2018-partial] - **Post-occlusion readiness:** communicate before deflation; anticipate acidosis/hyperkalemia/hypotension and treat proactively within DCR. [@spahn2019] <!-- type: table --> **Table 16.6. Common EVTM Complications and Immediate Responses** | **Problem** | **Typical cause** | **Immediate response** | | --- | --- | --- | | CFA dissection/thrombosis | Large sheath, poor puncture site | Maintain wire access; angiography; repair/covered stent vs open repair | | Limb ischemia | Sheath occlusion, prolonged Zone III occlusion | Reduce sheath size if possible; consider distal perfusion strategy; monitor compartments | | Severe metabolic derangement at deflation | Prolonged occlusion | Staged deflation; treat hyperkalemia/acidosis; vasopressors as bridge | | Stent thrombosis | Low flow, inadequate antithrombotic plan | Restore flow; individualized antithrombotic strategy after hemostasis | | Endograft infection | Contamination/bacteremia | Early suspicion; antibiotics; consult vascular/infectious disease; consider explant in selected cases. [@esvsvgei2020] | The spectrum of resuscitative endovascular balloon occlusion of the aorta (REBOA)-related complications — including vascular access injury, limb ischemia, and end-organ ischemia from prolonged occlusion — has been further characterised in updated reviews, reinforcing the importance of the prevention strategies outlined above. [@marcelo2024-h] Cross-reference: [[resuscitative endovascular balloon occlusion of the aorta (REBOA)]] and [[Massive Transfusion]]. [@bulger2019] [@spahn2019]