Perioperative Outcomes and Safety of Resuscitative Endovascular Balloon Occlusion of the Aorta in Ruptured Abdominal Aortic Aneurysm Repair: A Propensity-Matched Cohort Study

Resuscitative endovascular balloon occlusion of the aorta demonstrated high technical success and an excellent safety profile in rAAA repair. Its use was associated with improved intraoperative hemodynamic stability (higher diastolic BP) and a reduced rate of MACE, although it did not significantly impact mortality or survival. Larger, prospective trials are warranted to confirm the observed reduction in MACE. The comparative outcomes of REBOA in OSR versus EVAR settings remain inconclusive due to the limited sample size.Clinical ImpactThis study demonstrates that resuscitative endovascular balloon occlusion of the aorta (REBOA) in ruptured abdominal aortic aneurysm (rAAA) repair is safe and feasible, and is associated with improved intraoperative hemodynamics and reduced major adverse cardiovascular events. For clinicians, these findings support its use for unstable rAAA patients, particularly those with refractory shock or challenging anatomy. Resuscitative endovascular balloon occlusion of the aorta may serve as both a resuscitative and a cardioprotective strategy by augmenting coronary perfusion. The innovation lies in validating its contemporary safety and proposing a mechanism for cardiac benefits, potentially changing risk-benefit assessments in emergency aortic surgery.