Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporary control non-compressible truncal hemorrhage (NCTH) as bridge to definitive surgical treatment. The dependence on radiography for safe balloon positioning is one factor that limits the extended use of REBOA in civilian and military pre-hospital settings. We aimed to determine standardized sex and age-based variable-distance catheter insertion lengths for accurate REBOA placement without initial fluoroscopic confirmation. Contrast enhanced CT-scans from a representative sample of a Dutch non-trauma population were retrospectively analyzed. Intravascular distances were measured from the bilateral common femoral artery access points (FAAP) to the middle of the aortic occlusion zones and accompanying boundaries. Means and 95% confidence intervals for the distances from the FAAPs to the boundaries and mid-zone III were calculated for all (combined) sex and age-based subgroups. Optimal insertion lengths and potentially safe regions were determined for these groups. Bootstrap analysis was performed in combination with a 40-mm long balloon introduction simulation to determine error-rates and REBOA placement accuracy for the general population. In total, 1354 non-trauma patients (694 females) were included. Vascular distances increased with age and were longer in males. The iliofemoral trajectory was 7 mm longer on the right side. The optimal zone I catheter insertion length would be 430 mm. Optimal zone III catheter insertion lengths showed up to 30 mm difference, ranging between 234 and 264 mm. Statistically significant and potentially clinically relevant differences were observed between the anatomical distances and necessary introduction depths for each subgroup. This is the first study to compare aortic morphology and intravascular distances between combined sex and age-based subgroups. As zone III length was consistent, length variability and elongation seem to mainly originate in the iliofemoral trajectory and zone II. The optimal zone I catheter insertion length would be 430 mm. Optimal zone III catheter insertion ranged between 234 and 264 mm. These standardized variable-distance insertion lengths could facilitate safer fluoroscopy-free REBOA in austere, pre-hospital settings.

中文翻译：

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探索主动脉形态并确定主动脉免透视复苏性血管内球囊闭塞 (REBOA) 的可变距离插入长度


主动脉复苏性血管内球囊闭塞术 (REBOA) 用于暂时控制不可压缩性躯干出血 (NCTH)，作为最终手术治疗的桥梁。气球安全定位对射线照相的依赖是限制 REBOA 在民用和军用院前环境中广泛使用的因素之一。我们的目的是确定基于性别和年龄的标准化可变距离导管插入长度，以便在无需初始荧光镜确认的情况下准确放置 REBOA。对荷兰非创伤人群代表性样本的对比增强 CT 扫描进行了回顾性分析。测量从双侧股总动脉接入点（FAAP）到主动脉闭塞区中部和伴随边界的血管内距离。计算所有（组合）基于性别和年龄的亚组从 FAAP 到边界和中区 III 的距离的平均值和 95% 置信区间。为这些组确定了最佳插入长度和潜在安全区域。 Bootstrap 分析与 40 毫米长的球囊引入模拟相结合，以确定一般人群的错误率和 REBOA 放置准确性。总共包括 1354 名非创伤患者（694 名女性）。血管距离随着年龄的增长而增加，男性的血管距离更长。右侧髂股轨迹长 7 毫米。最佳 I 区导管插入长度为 430 毫米。最佳 III 区导管插入长度差异达 30 毫米，范围在 234 至 264 毫米之间。每个亚组的解剖距离和必要的引入深度之间观察到统计学显着和潜在的临床相关差异。 这是第一项比较基于性别和年龄的亚组之间的主动脉形态和血管内距离的研究。由于 III 区长度一致，长度变异和伸长似乎主要源于髂股轨迹和 II 区。最佳 I 区导管插入长度为 430 毫米。最佳 III 区导管插入范围为 234 至 264 毫米。这些标准化的可变距离插入长度可以在严峻的院前环境中促进更安全的免透视 REBOA。