Placement of a balloon for resuscitative endovascular balloon occlusion of the aorta without fluoroscopic guidance in canine cadavers

OBJECTIVE: To determine whether a balloon for resuscitative endovascular balloon occlusion of the aorta (REBOA) could be accurately placed in the descending aorta between the left subclavian and celiac arteries (zone I) by using external anatomic landmarks in dogs. STUDY DESIGN: Cadaver study. SAMPLE POPULATION: Fifteen canine cadavers of 3 weight categories (10–20, 20–30, and ≥ 30 kg). METHODS: Percutaneous catheterization of the femoral artery was attempted under ultrasonographic guidance; when unsuccessful, an arterial cutdown was performed to place an introducer sheath. Distance was measured between the introducer sheath and the target region, located ventral to the epaxial muscles at the level of the 12th thoracic vertebra. The balloon was advanced the measured distance, and placement was confirmed with fluoroscopy. The volume of iohexol solution required to inflate balloons was recorded. Histopathology was performed on the aortas of the first 5 dogs. RESULTS: Three catheters were placed under ultrasonographic guidance. Balloons were successfully placed into zone I in 15 of 15 cadavers. Balloons were inflated with a median 0.4 mL/kg (range, 0.21–0.67) of iohexol solution. Minor changes were identified in 2 of 5 dogs examined with histopathology (linear defects in 1 dog, small focal dissection in the other). CONCLUSION: A balloon for REBOA was consistently placed in the target zone I without fluoroscopic guidance. CLINICAL SIGNIFICANCE: Fluoroscopy may not be required for zone I REBOA in dogs. Additional studies are warranted to evaluate the feasibility of REBOA in clinical dogs with hemoperitoneum.