Resuscitative Endovascular Balloon Occlusion of the Aorta

For resuscitative endovascular balloon occlusion of the aorta (REBOA), an endovascular balloon is placed in the aorta to control hemorrhage, as well as to maintain myocardial and cerebral perfusion in traumatic arrest and hemorrhagic shock by augmenting afterload.

Average diameter of the aorta

• ■

  Thoracic aorta: 20 mm

• ■

  Distal abdominal aorta: 15 mm

• ■

  On average, the aorta is 2 mm narrower in women than in men.

Aortic length

• ■

  Varies among individuals

• ■

  Abdominal aorta from the level of celiac artery to its bifurcation is approximately 13 cm long.

Externally, the abdominal aorta can be measured from the xiphoid process to just above the umbilicus.

Zones of REBOA

• ■

  Aorta is divided into three separate zones for the purpose of REBOA balloon deployment.

• ■

  Zone I

  • ■

    Extends from the origin of the left subclavian artery to the celiac artery

  • ■

    Approximately 20 cm long in adults

  • ■

    Estimated externally to extend from the medial head of the clavicle or sternal notch to the xiphisternum, or T4 vertebra to L1 vertebra, or T4 vertebra to 12th rib.

• ■

  Zone II

  • ■

    Extends from the celiac artery to the most caudal renal artery

  • ■

    Approximately 3 cm long.

  • ■

    REBOA balloon is not recommended in this zone.

• ■

  Zone III

  • ■

    Extends distally from the most caudal renal artery to the aortic bifurcation

  • ■

    Approximately 10 cm long

  • ■

    Estimated externally to extend from L2 vertebra to L4 vertebra, or from the xiphisternum to the umbilicus