J Trauma Acute Care Surg. 2019 Jan;86(1):155-159

# Endovascular control of pelvic hemorrhage: Concomitant use of resuscitative endovascular balloon occlusion of the aorta and endovascular intervention.

Adnan S, Wasicek P, Crawford A, Dubose J, Brenner M, Scalea T, Morrison J

CONCLUSIONS: We describe the technical considerations for endovascular interventions concurrent with REBOA use in patients with pelvic hemorrhage. Determining the access site for angiography and intervention is a major therapeutic consideration in pelvic hemorrhage, with options including upper and lower extremity arteries, each with practical considerations. Lower extremity access affords the use of shorter systems but can be more challenging in terms of vessel access and the maneuvering of wires and catheters. Upper extremity access can be a useful way of avoiding the groin region altogether but involves specialist equipment and limits some endovascular interventions such as large diameter-covered stent-graft deployment. The use of upper or lower extremity access should be made on the basis of patient factors and clinical capability. Further research is required in this area to optimize the timely care of this critical patient group.