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The REBOA window: a cadaveric study delineating the optimum site for austere cannulation of the femoral artery for resuscitative endovascular balloon occlusion of the aorta
  1. Naim Slim1,
  2. C T West1,2,
  3. P Rees3,4,
  4. C Brassett1 and
  5. M Gaunt1
  1. 1Human Anatomy Teaching Group; Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, Cambridgeshire, UK
  2. 2Department of Colorectal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  3. 3Academic Department of Military Medicine, Bart's Heart Centre, London, United Kingdom
  4. 4School of Medicine, University of St Andrews, St Andrews, UK
  1. Correspondence to Major C T West, Colorectal Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; ctimothyw{at}gmail.com

Abstract

Introduction Haemorrhage is the major cause of early mortality following traumatic injury. Patients suffering from non-compressible torso haemorrhage are more likely to suffer early death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be effective in initial resuscitation; however, establishing swift arterial access is challenging, particularly in a severe shock. This is made more difficult by anatomical variability of the femoral vessels.

Methods The femoral vessels were characterised in 81 cadaveric lower limbs, measuring specifically the distance from the inferior border of the inguinal ligament to the distal part of the origin of the profunda femoris artery (PFA), and from the distal part of the origin of the PFA to where the femoral vein lies posterior to and is completely overlapped by the femoral artery.

Results The femoral vein lay deep to the femoral artery at a mean distance of 105 mm from the inferior border of the inguinal ligament. The PFA arose from the femoral artery at a mean distance of 51.1 mm from the inguinal ligament. From the results, it is predicted that the PFA originates from the common femoral artery approximately 24 mm from the inguinal ligament, and the femoral vein is completely overlapped by the femoral artery by 67.7 mm distal from the inguinal ligament, in 95% of subjects.

Conclusions Based on the results, proposed is an ‘optimal access window’ of up to 24 mm inferior to the inguinal ligament for common femoral arterial catheterisation for pre-hospital REBOA, or more simply within one finger breadth.

  • anatomy
  • adult intensive & critical care
  • trauma management
  • adult surgery
  • vascular surgery
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Footnotes

  • Twitter @charliewest89, @DrPaulRees

  • Contributors NS wrote main manuscript, performed data collection and undertook revisions. CTW edited main manuscript, performed data collection and undertook revisions. PR provided expert input on the applicability of the study to REBOA. CB coordinated data collection and supervised study. MG supervised study and proposed research idea.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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