Prospective evaluation of the correlation between torso height and aortic anatomy in respect of a fluoroscopy free aortic balloon occlusion system

Authors

Jonathan J. Morrison, The Academic Department of Military Surgery & Trauma, Academic Unit of Surgery, Air Force Medical Support Agency
Adam Stanard, The Academic Department of Military Surgery & Trauma
Mark. J. Midwinter, The Academic Department of Military Surgery & Trauma
Danny J. Sharon, The Division of Vascular Surgery
Jonathan L. Eliason, University of Michigan - Ann Arbor
Todd E. Rasmussen, Academic Unit of Surgery, Uniformed Services University of the Health SciencesFollow

Date of this Version

2014

Citation

Surgery, Volume 155, Issue 6, June 2014, Pages 1044-1051

Comments

This article is a U.S. government work, and is not subject to copyright in the United States.

Abstract

Background. To report the lengths of key torso vascular and to develop regression models that will predict these lengths, based on an external measure of torso height (EMTH, sternum to pubis) in the development of a fluoroscopy-free balloon occlusion system for hemorrhage control. Methods. We conducted a prospective, observational study at a Combat Support Hospital in Southern Afghanistan using adult male patients undergoing computed tomography (CT). EMTH was recorded using a tape measure and intra-arterial distance was derived from CT imaging. Regression models to predict distance from the common femoral artery (CFA) into the middle of aortic zone I (left subclavian artery to celiac trunk) and zone III (infrarenal aorta) were developed from a random 20% of the cohort and validated by the remaining 80%. Results. Overall, 177 male patients were included with a median (interquartile range [IQR]) age of 23 (8) years. The median (IQR) lengths of aortic zone I and III were 222 (24), 31 (9), and 92 (15) mm. The mid-zone distance from the left and right CFA to zone I were 423 (27) and 418 (29) and for zone III 232 (21) and 228 (22). Linear regression models demonstrated an accuracy between 99.3% to 100% at predicting the insertion distance required to place a catheter within the middle of each aortic zone. Conclusion. This study demonstrates the use of morphometric analysis in the development of a fluoroscopy-free balloon occlusion system for torso hemorrhage control. Further study in a larger population of mixed gender is required to further validate insertion models. (Surgery 2014;155:1044- 51.)