EVTM in Trauma: Early Vascular Access, REBOA and Hybrid Hemorrhage Control

Modern trauma surgery is increasingly defined not only by what happens after laparotomy, but by how early the team creates options for hemorrhage control. This lecture introduces the EVTM concept — gaining vascular access early enough to make endovascular resuscitation, embolization, stent grafting, REBOA or hybrid surgery immediately available when a patient's physiology deteriorates.

The speaker walks through the modified trauma workflow used in Örebro, including early ultrasound-guided femoral access, semi-hybrid and hybrid operating rooms, multidisciplinary trauma organization and the practical logic behind choosing open, endovascular or combined treatment. REBOA is discussed in detail: patient selection, total versus partial occlusion, hemodynamic targets, complications, registry data and why technical familiarity may matter as much as the device itself.

Clinical cases show how the same vascular access can completely change the next step — from treating an unexpected subclavian artery injury to managing pelvic hemorrhage, gastrointestinal bleeding, cardiac arrest and severe extremity trauma. The closing mass-casualty case brings these principles together: damage-control decisions, partial REBOA, vascular reconstruction and the complications that remind us that endovascular tools are powerful precisely because they demand disciplined use.