Use of temporary partial intrailiac balloon occlusion for decreasing blood loss during open reduction and internal fixation of acetabular and pelvis fractures

Summary: Patients with pelvic and/or acetabular fractures can sustain significant blood loss at the time of their injury and during surgery. We report on the technique, effect on blood loss, and complications with the use of temporary partial intrailiac balloon occlusion during open reduction and internal fixation of pelvic and acetabular fractures in a series of patients refusing allogeneic blood products for philosophical or religious reasons. An intra-arterial balloon is positioned in the common iliac artery immediately preoperatively, ipsilateral to the fracture in the interventional radiography suite. This balloon is then periodically inflated and deflated throughout the case by the anesthesiologist to mitigate operative blood loss. For anterior approaches, average blood loss was significantly less for those patients operated with temporary partial intrailiac balloon occlusion compared with those without. For posterior approaches, blood loss was not significantly different. One complication occurred in a patient who developed an arterial thrombus requiring surgical removal by the vascular surgery service at the conclusion of the orthopaedic surgery. He had no further sequelae. Although not recommended for routine use in all pelvic and acetabular fractures, we feel the use of temporary partial intrailiac balloon occlusion merits further study and may be beneficial in reducing blood loss during anterior pelvic or acetabular procedures in those patients who are opposed to allogeneic blood products and cell saver or those who cannot tolerate an anticipated massive blood loss.