Endovascular Localization of Aortic Injury in a Porcine Model

Goal: Non-compressible torso hemorrhage represents a category of lethal injuries in both civilian and military traumatically injured populations that with proper intervention, training, or technological advancements are survivable. Endovascular localization of active bleeding in the pre-hospital setting can allow faster, less invasive, and more accurate applications of life-saving interventions. In this paper, we report initial in vivo and in silico experimental results to test the feasibility of endovascular localization of hemorrhage. Methods: Endovascular pressure waveforms were acquired on five pigs with an induced aortic injury via a custom intra-aortic catheter instrumented with four pressure sensors. Pressure and velocity data were then simulated on an in silico human aortic model with the same kind of injury. Results: A decrease in pulse pressure across the injury (proximal to distal) reliably indicated the injury location to within a few centimeters. The simulated model showed a similar decrease in pulse pressure as well as an increase in velocity. Conclusions: With additional refinement, localization accuracy may be sufficient for application of a modern covered stent to stop bleeding. The simulated model results indicate relevance for humans and provide guidance for future experiments.