Balloon catheter tamponade in cardiovascular wounds
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D V Feliciano1, J M Burch, K L Mattox
1Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas.
Insights
Operative balloon catheter tamponade effectively treated penetrating cardiac and vascular injuries in 12 patients. This minimally invasive technique demonstrated high survival rates, offering a viable option for hemorrhage control.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Interventional Radiology
Background:
- Penetrating trauma frequently causes life-threatening cardiac and vascular injuries.
- Traditional surgical repair can be complex and carry significant risks.
- Minimally invasive techniques are increasingly sought for hemorrhage control.
Purpose of the Study:
- To evaluate the efficacy and safety of operative balloon catheter tamponade for managing penetrating cardiac and vascular injuries.
- To assess outcomes of both temporary and permanent balloon catheter placements.
Main Methods:
- Retrospective review of 12 patients treated between 1980 and 1990.
- Balloon catheter insertion into the bleeding site via bullet track or artery.
- Inflation with saline or radiologic dye for tamponade.
- Temporary postoperative inflation or permanent placement.
Main Results:
- Nine patients with various injuries underwent balloon tamponade; eight survived without recurrent hemorrhage.
- One patient with carotid siphon Fogarty balloon placement died of cerebral infarction.
- Four patients with arteriovenous fistulas and cardiac/vena cava wounds survived, though some required re-intervention.
Conclusions:
- Operative balloon catheter tamponade is a feasible and effective method for controlling hemorrhage from penetrating injuries.
- While generally safe, potential complications like cerebral infarction exist.
- The technique offers a less invasive alternative for specific vascular and cardiac trauma cases.
Abstract:
From 1980 to 1990, operative balloon catheter tamponade was used in 12 patients with cardiac or vascular injuries from penetrating wounds. In nine patients, a balloon catheter was passed into a bleeding site through a bullet track or proximal artery and inflated with saline or radiologic dye. In two of these patients, the proximal balloon catheter was folded on itself, tied in that position, and left in the patient permanently. In the other seven patients in this group, the balloon catheter was attached to a three-way stopcock and left temporarily inflated postoperatively. These patients were then observed in the intensive care unit for 3 to 4 days, at which time the balloon was withdrawn. Eight of nine patients survived without recurrent hemorrhage after removal of the balloon catheter, while one patient with a Fogarty balloon placed in the carotid siphon died of a cerebral infarction. Balloon catheter tamponade was also used on a temporary basis in one patient with a posterior cardiac wound and in one patient with an anterior stab wound of the inferior vena cava at the renal veins, whereas in two patients with high cervical arteriovenous fistulas, one had permanent placement of the balloon catheter while the other had temporary placement. One of the latter patients also had acute hemorrhage. Although all four patients survived, one of the patients with a fistula developed a recurrence and another required two separate operative procedures for correct placement of the balloon to cure the fistula.