Common iliac artery dissection as a complication of common iliac artery balloon occlusion for placenta percreta: A case report

• Published in: The journal of obstetrics and gynaecology research Vol. 47; no. 3; pp. 1172 - 1177
• Main Authors: Saito, Kimihito, Mariya, Tasuku, Fujibe, Yuya, Saito, Masato, Hirokawa, Naoki, Ishioka, Shinichi, Saito, Tsuyoshi
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.03.2021; Wiley Subscription Services, Inc
• Subjects: Angiography; Balloon treatment; bilateral common iliac artery balloon occlusion; Case reports; common iliac artery dissection; Contrast media; Dissection; Hysterectomy; Ischemia; Mechanical stimuli; Occlusion; Placenta; placenta percreta; Surgery; Surgical outcomes; Veins & arteries; placenta percreta; bilateral common iliac artery balloon occlusion; common iliac artery dissection
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.14601

A 37‐year‐old pregnant woman who had undergone three previous cesarean sections was diagnosed as having placenta percreta. We decided to perform cesarean hysterectomy with bilateral common iliac artery balloon occlusion (CIABO). The duration of surgery was 2 h and 2 min and total estimated blood loss was 2600 mL. Surgery was completed without any surgical complications, but the pulse oximeter waveform of the left leg became undetectable during surgery. We immediately performed angiography after closure of laparotomy and found abnormal pooling of contrast media at the left common iliac artery in the region in which the balloon was positioned. We made a diagnosis of left common iliac artery dissection caused by CIABO. We performed emergent revascularization by intravascular stenting. We conclude that CIABO can cause common iliac artery dissection by mechanical stimulation of the inflated balloon. Careful intraoperative evaluation of limb ischemia and preparation of intravascular treatment is needed for a safe procedure.