Perioperative Endovascular Internal Iliac Artery Occlusion Balloon Placement in Management of Placenta Accreta

• Published in: American journal of roentgenology (1976) Vol. 189; no. 5; pp. 1158 - 1163
• Main Authors: Tan, Cher Heng, Tay, Kiang Hiong, Sheah, Kenneth, Kwek, Kenneth, Wong, Kenneth, Tan, Hak Koon, Tan, Bien Soo
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.11.2007; American Roentgen Ray Society
• Subjects: Adult; Balloon Occlusion - methods; Biological and medical sciences; Blood Loss, Surgical - prevention & control; Cesarean Section - adverse effects; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; Embolization, Therapeutic - methods; Female; Gravidity; Gynecology. Andrology. Obstetrics; Humans; Iliac Artery; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Perioperative Care - methods; Placenta Accreta - surgery; Pregnancy; Pregnancy. Fetus. Placenta; Treatment Outcome; Human; Postoperative; Nuclear medicine; Pregnancy disorders; Endovascular route; Placenta diseases; Iliac artery; Placenta accreta; Perioperative; Clinical management; Treatment; Surgery; Radiology; Delivery disorders; Artery occlusion
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.07.2417

The purpose of our study was to evaluate the efficacy of the perioperative placement of occlusion balloons within the internal iliac arteries in reducing intraoperative blood loss and transfusion requirements during cesarean delivery for women with placenta accreta or its variants. Over a 30-month period, 11 patients with placenta accreta or its variants underwent cesarean delivery after bilateral internal iliac artery occlusion balloon placement (study group). The intraoperative blood loss and transfusion volumes, immediate postoperative change in hemoglobin levels, duration of surgery, and length of ICU stay and hospitalization of this study group were compared with 14 similar patients who underwent cesarean delivery without occlusion balloon placement over a 36-month period (control group). The mean intraoperative blood loss in the study group (2,011 mL; range, 400-5,000 mL) was 39.4% less than in the control group (3,316 mL; range, 1,000-4,000 mL) (p = 0.042). The mean volume of blood transfused was 52.1% less in the study group (1,058 mL; range, 0-3,600 mL) than in the control group (2,211 mL; range, 1,190-3,980 mL) (p = 0.005). There was no significant difference in the immediate postoperative change in hemoglobin levels (p = 0.44), length of hospitalization (p = 0.203), or ICU admission (p = 0.614). The duration of the surgery was significantly less in the study group (p = 0.046). Perioperative internal iliac artery occlusion balloon placement is a safe and minimally invasive technique that reduces intraoperative blood loss and transfusion requirements in patients with placenta accreta and its variants undergoing cesarean delivery.