P-049 - A REVIEW OF THE CONTEMPORARY USES OF INFERIOR VENA CAVA BALLOON OCCLUSION

TOPIC:
Other
AUTHORS:
Haran C. (Department of Vascular Surgery, Wellington Hospital ~ Wellington ~ New Zealand) , Sivakumaran Y. (Department of Vascular Surgery, Princess Alexandra Hospital ~ Brisbane ~ Australia)
Introduction:
With the advent of the hybrid operative environment, the utility of inferior vena cava balloon occlusion (IVCBO) has continued to expand with its ability to be introduced through open or percutaneous means. The current literature for outlining the physiology and potential uses of the IVCBO is scant. Our aim was to perform a narrative review of the contemporary uses of IVCBO.
Methods:
A literature search was undertaken of Medline, Web of Science and Google Scholar from inception to February 2022. All published study designs, including case reports, in English language were included. Animal and human studies were included. No studies were excluded.
Results:
IVCBO was first described in 1964 and is noted to assist cardiac preload manipulation which can induce systemic hypotension. The physiological impact of IVCBO is unpredictable however may be improved with the concurrent occlusion of the aorta to reduce venous pooling. Time of onset of hypotension can range from 15 to 90 seconds to achieve a blood pressure of 50mmHg. Prolonged balloon occlusion was often not well tolerated and as such inotropic or vasoconstrictor support, transient peripheral veno-veno or atrio-caval bypass may be necessary. IVCBO was initially investigated in the management of acute decompensated heart failure and management of venous thromboembolism. Contemporary uses have expanded to the deployment of the thoracic endoprosthesis, repair of aorto-caval fistulas, successful removal of IVC thrombus secondary to renal malignancy and abdominal IVC trauma. Recent developments in IVCBO use have expanded to the potential use of intermittent occlusion as an implantable device to assist patients with reduced ejection fraction and exercise tolerance.
Conclusion:
IVCBO has a vast array of uses, though the reported incidence of it's use is low across each of the potential indications. There are no large case series or randomised control trials of the use of IVCBO in the management of medical and surgical patients for its various possible uses. With successful precautions and the support of the vascular surgeon, the use of IVCBO may augment the treatment of various pathology.