Two Cases of Aorto-Duodenal Fistula That Were Successfully Managed by REBOA During Surgery for Hemorrhage Control

Abstract

Aorto-duodenal fistulas (ADFs) are associated with a high mortality rate due to massive hemorrhage before and during surgery, as well as postoperative complications. Successful resuscitation often hinges on effective temporary bleeding control during these critical phases. We report two cases of ADF in which resuscitative endovascular balloon occlusion of the aorta (REBOA) was employed for intraoperative hemorrhage control. In Case 1, REBOA was used to stabilize a patient with massive preoperative hemorrhage, followed by replacement with a vascular graft. In Case 2, prophylactic REBOA was performed in a patient with relatively stable hemodynamics to facilitate elective surgical repair. Both patients were discharged without major postoperative complications. However, one patient developed a REBOA-related arterial dissection at the puncture site, which resolved with conservative management. These cases suggest that REBOA may be an effective adjunct for improving safety during emergency surgery for ADF.