A Guide to Femoral Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta


  • Futoshi Nagashima Toyooka Public Hospital, Department of Tajima Emergency and Critical Care Medical Center
  • Yuri Kon St. Marianna University School of Medicine, Department of Emergency and Critical Care Medicine
  • Takuya Sugiyama Department of Anesthesiology, Chiba Emergency Medical Center
  • Kenichiro Ishida Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization
  • Takaaki Maruhashi Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine
  • Yosuke Matsumura Department of Intensive Care, Chiba Emergency Medical Center,


blind/landmark technique, ultrasound-guided technique, surgical cutdown technique, short-axis puncture, long-axis puncture, single-wall puncture method, double-wall puncture method



Arterial access is essential in resuscitation of trauma and hemorrhagic shock patients and can be effectively used for rapid endovascular treatment such as resuscitative endovascular balloon occlusion of the aorta (REBOA) and interventional radiology (IVR), continuous invasive hemodynamic monitoring, and frequent blood tests. In the REBOA procedure, obtaining an arterial access is the first and most critical step. Arterial access can be obtained in three ways: i) blind/landmark technique, ii) ultrasound-guided technique, or iii) surgical cutdown technique. Regardless of which technique is chosen, it is crucial to recognize external landmarks before implementing any technique. 


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Narrative Review Article