What is EVTM?

What is Endovascular Hybrid Trauma and Bleeding Management (EVTM)?

In the last 20 years, endovascular interventions have been increasing in trauma management. At first, these procedures were mostly used in the management of aortic aneurysms, but over time, the purpose of use expanded towards trauma. In recent years, EVTM procedures have become widespread with the developments in imaging methods (ultrasonography, computed tomography, Doppler US, angiography, etc.).

EVTM interventions include REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta), and other hemorrhage control methods such as embolization, stenting, and methods that provide repair of damage caused by trauma. These minimally invasive methods, which contribute to survival, especially in hemodynamically unstable trauma patients, are spreading rapidly in the world. However, it should be noted that EVTM mainly focuses on temporary hemodynamic stabilization and should never be used as a substitute for open surgery when necessary. Until definitve treatment is established, EVTM saves a short but very valuable time for the patient and the physician.

It is now accepted that EVTM is one of the complementary elements in trauma management. It is vital to apply EVTM procedures in the early stages of trauma. It has been clearly demonstrated in the literature that the rate of death caused by trauma is lower with the bleeding control provided by EVTM in the prehospital period. For this reason, pre-hospital EVTM is strengthening its place in the world, especially in war and disaster medicine. The hybrid use of EVTM with open surgery brings a new breath to trauma management. Thus, it is necessary to change the classical perspective in trauma management. Considering the deaths due to trauma in our country, it is undoubted that the knowledge of EVTM methods and the widespread use of EVTM methods in both pre-hospital and emergency services will be a big step in preventing the loss of the young population of our country.

One of the most popular methods in endovascular trauma management is seen as REBOA. REBOA, which is widely used in the temporary stabilization of hemodynamics in many centers around the world, has even replaced emergency resuscitative thoracotomy in the management of non-compressible abdominal and thoracic traumas. Almost no center in our country has the necessary equipment (materials, knowledge, experience) for EVTM or REBOA. As TREVTM, our main goal is to explain what EVTM procedures including REBOA are, how they are done, in which situations and to whom they should be done, and to encourage the use of these life-saving procedures throughout the country.