Sat., 10/16/10 Pelvis & Spine, Paper #81, 3:59 pm OTA-2010
Use of Temporary Partial Intrailiac Balloon Occlusion for Decreasing Blood Loss during Open Reduction and Internal Fixation of Acetabular and Pelvic Fractures
Justin C. Siebler, MD; Thomas DiPasquale, MD; H. Claude Sagi, MD;
Florida Orthopaedic Institute, University of South Florida, Tampa, Florida, USA
Purpose: This is a report on the technique, effect on blood loss, and complications of temporary partial intrailiac balloon occlusion (TPIIBO) during open reduction and internal fixation of pelvic and acetabular fractures.
Methods: We conducted a retrospective review of skeletally mature patients having surgical treatment of traumatic pelvic or acetabular fractures. All patients refused allogeneic blood transfusion and were enrolled in a prospective database for placement of a TPIIBO. Immediately preceding surgery, the patient is taken to the interventional radiology suite. An inflatable balloon is placed, via the contralateral femoral artery, into the common iliac artery ipsilateral to the pelvic or acetabular injury. An arterial line is placed into the posterior tibial or dorsalis pedis artery of the ipsilateral extremity to monitor blood flow to the distal extremity. During the course of the operative procedure, the anesthesiologist intermittently inflates and deflates the balloon at 10-minute intervals. The balloon is removed at the termination of the surgical procedure. Individual records were reviewed for estimated blood loss (EBL) and complications. EBL was compared to the average EBL for similar cases and approaches performed by the same surgeons at the same institution.
Results: We report on 10 patients operated for pelvic or acetabular fractures with TPIIBO. Average blood loss for anterior approaches was 365 mL with the intrailiac balloon (range, 175-600 mL) and 795 mL without the balloon (range, 125-2500 mL) (P < 0.001). Average blood loss for posterior approaches was 575 mL with the balloon and 445 mL without the balloon (not significant). One complication occurred (10%) in a patient with an anterior column fracture who developed an arterial thrombus and an ipsilateral ischemic extremity intraoperatively. The vascular surgical service successfully performed a thrombectomy and he had no further sequelae.
Conclusions: TPIIBO appears to decrease the overall average blood loss for anterior pelvic and acetabular surgical procedures. Its effect on blood loss for posterior acetabular procedures is undetermined. We report one complication of arterial thrombus that required intraoperative thrombectomy and resulted in no adverse outcome. We feel the use of TPIIBO may be beneficial in reducing blood loss during anterior pelvic or acetabular procedures for those patients who are opposed to allogeneic blood products.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.