Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging intervention for noncompressible torso hemorrhage. We report the case of a 64-year-old man who presented with abdominal pain and hypotension due to a ruptured abdominal aortic aneurysm in South Korea. Upon clinical deterioration, temporary aortic occlusion was achieved using antegrade REBOA via the left brachial artery in the operating room. A balloon catheter was successfully placed proximal to the aneurysm using the Seldinger technique, resulting in rapid stabilization of vital signs. Definitive surgical repair with aortic replacement was then performed without complications. The patient fully recovered and was discharged 1 month later. This case demonstrates the clinical utility of antegrade REBOA when retrograde insertion is contraindicated, particularly in juxtarenal aneurysms. REBOA can provide a critical window for hemodynamic stabilization and surgical control in cases of life-threatening hemorrhage. Careful consideration of access site, balloon positioning, and imaging guidance is essential for safely and effectively deploying this technique.

Purpose
This study aimed to evaluate the utilization and outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in managing noncompressible torso hemorrhage (NCTH) among trauma patients in Korea. The evolution of REBOA and its impact on patient survival was investigated as well as predictors of mortality.
Methods
This retrospective study included 234 post-REBOA patients from 5 leading regional trauma centers across Korea between 2016 and 2021. Primary outcomes were in-hospital mortality, and secondary outcomes were various clinical parameters regarding REBOA, overall treatment flow, and complications. For comparative analyses, patients were dichotomized into in-hospital non-survivors or survivors. Then, generalized additive and linear regression models were used to evaluate the trend of in-hospital mortality.
Results
The overall in-hospital mortality was 65.4%. The survivors had a higher proportion of responders following REBOA (87.7% vs 62.7%, p < 0.001). Key variables influencing outcomes included total occlusion time, red blood cell transfusion volume within the first 24 hours, revised trauma score, and systolic blood pressure gap. These factors significantly correlated with mortality rates in multivariate logistic regression.
Conclusion
Over 6 years, survival rates for NCTH patients undergoing REBOA in Korea have shown improvement. Despite diverse REBOA protocols across institutions, the results underscore the need for continued research, standardized practices, and national quality control measures to further optimize patient outcome and establish more effective treatment protocols for NCTH.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective resuscitative modality to temporize noncompressible truncal hemorrhage. Confirming the proper position of the balloon catheter in the target aortic zone is vital. Currently, there is a need for nonradiographical methods. This would overcome the drawbacks of conventional imaging modalities, such as fluoroscopy. Several studies have suggested ultrasound-guided visualization via subxiphoid, transperitoneal, or transesophageal views as an alternative to conventional imaging methods. However, such views are easily obscured in emergency settings. Herein, we report the case of a 70-year-old patient who was successfully resuscitated by REBOA under the guidance of transsplenic ultrasound. REBOA was safely performed using transsplenic visualization without fluoroscopy.

Citations

• Resuscitative endovascular balloon occlusion of the aorta in abdominal trauma: zone-specific outcomes and predictors of mortality
  Musaed Rayzah, Nasser A. N. Alzerwi, Bandar Idrees, Ahmed A. Alhumaid, Yaser Baksh, Fares Rayzah
  International Journal of Emergency Medicine.2026;[Epub]     CrossRef