PMID- 31246918
OWN - NLM
STAT- MEDLINE
DCOM- 20200528
LR  - 20200528
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 87
IP  - 1S Suppl 1
DP  - 2019 Jul
TI  - Computed tomography correlation of skeletal landmarks and vascular anatomy in 
      civilian adult trauma patients: Implications for resuscitative endovascular 
      balloon occlusion of the aorta.
PG  - S138-S145
LID - 10.1097/TA.0000000000002247 [doi]
AB  - BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is 
      a valuable resuscitative adjunct in a variety of clinical settings. In 
      resource-limited or emergency environments, REBOA may be required with delayed or 
      absent image-guidance or verification. Catheter insertion lengths may be informed 
      by making computed tomography (CT) correlations of skeletal landmarks with 
      vascular lengths. METHODS: Between 2000 and 2015 at a single civilian tertiary 
      care center, 2,247 trauma patients with CT imaging were identified, yielding 
      1,789 patients with adequate contrast opacification of the arterial system in the 
      chest, abdomen, and pelvis. Individual scans were analyzed using MATLAB software, 
      with custom high-throughput image processing algorithms applied to correlate 
      centerline vascular anatomy with musculoskeletal landmarks. Data were analyzed 
      using R version 3.3. RESULTS: The median centerline distance from the skin access 
      to the aortic bifurcation was longer by 0.3 cm on the right than on the left 
      side. Median aortic zone I length was 21.6 (interquartile range, 20.3-22.9) cm, 
      while zone III was 8.7 (7.8-9.5) cm. Torso extent (TE) correlation to zone I was 
      much higher than that for zone III (R2, 0.58 vs. 0.26 (right) and 0.58 vs. 0.27 
      (left); p < 0.001). Assuming a 4-cm balloon length, optimal fixed insertion 
      length would be 48 cm and 28 cm for zones I and III (error, 0.4% vs. 33.3%), 
      respectively, although out of zone placements can be reduced if adjusted for TE 
      (error, 0% vs. 26.4%). CONCLUSION: Computed tomography morphometry suggests that 
      a fixed REBOA catheter insertion length of 48 cm for zone I and 28 cm for zone 
      III is optimal (on average, for average-height individuals), with improved 
      accuracy by formulaic adjustments for TE. High residual error for zone III 
      placement may require redesign of existing catheter balloon lengths or 
      consideration of the relative risk associated with placing the balloon catheter 
      too low or too high. LEVEL OF EVIDENCE: Prognostic/epidemiological, level III.
FAU - Eliason, Jonathan L
AU  - Eliason JL
AD  - From the Section of Vascular Surgery (J.L.E.); Morphomics Analysis Group (MAG) 
      (B.A.D., S.R.H., N.C.W., S.A.H., C.-H.C., B.E.R. B.B., S.C.W.), University of 
      Michigan; Department of Surgery (J.M.), University of Maryland; and Division of 
      Acute Care Surgery (S.C.W.), University of Michigan.
FAU - Derstine, Brian A
AU  - Derstine BA
FAU - Horbal, Steven R
AU  - Horbal SR
FAU - Wang, Nicholas C
AU  - Wang NC
FAU - Holcombe, Sven A
AU  - Holcombe SA
FAU - Chiu, Chien-Hung
AU  - Chiu CH
FAU - Ross, Brian E
AU  - Ross BE
FAU - Bromwell, Brenna
AU  - Bromwell B
FAU - Morrison, Jonathan
AU  - Morrison J
FAU - Wang, Stewart C
AU  - Wang SC
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - IM
MH  - Adult
MH  - Anatomic Landmarks
MH  - *Aorta
MH  - *Balloon Occlusion
MH  - Blood Vessels/*diagnostic imaging
MH  - Catheterization/*methods
MH  - Correlation of Data
MH  - *Endovascular Procedures
MH  - Female
MH  - Humans
MH  - Male
MH  - Musculoskeletal System/*anatomy & histology/*diagnostic imaging
MH  - Resuscitation/*methods
MH  - Retrospective Studies
MH  - *Tomography, X-Ray Computed
MH  - Vascular System Injuries/*surgery
MH  - Young Adult
EDAT- 2019/06/28 06:00
MHDA- 2020/05/29 06:00
CRDT- 2019/06/28 06:00
PHST- 2019/06/28 06:00 [entrez]
PHST- 2019/06/28 06:00 [pubmed]
PHST- 2020/05/29 06:00 [medline]
AID - 01586154-201907001-00021 [pii]
AID - 10.1097/TA.0000000000002247 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S138-S145. doi: 
      10.1097/TA.0000000000002247.