Background Placenta accreta spectrum (PAS) is abnormal placental adhesion beyond superficial myometrium, which may lead to severe life-threatening hemorrhage requiring massive blood transfusions in the peripartum period. Prophylactic balloon catheterization of bilateral internal iliac arteries with or without additional embolization with Cesarean hysterectomy in patients with PAS prevent excessive intraoperative hemorrhage and may also obviate the need for hysterectomy. Purpose To study the efficacy of intervention radiological procedures in controlling intraoperative hemorrhage in patients with PAS. Material and Methods This ethically approved prospective study was conducted between November 2017 and October 2019 and written informed consent was obtained from all patients. Consecutive patients diagnosed with PAS during the antepartum period were evaluated. A total of 18 patients with PAS underwent prophylactic balloon catheterization of the bilateral internal iliac arteries followed by delivery of the infant. Interventional and intraoperative data of these patients were collected and compared with retrospectively collected data of patients (control group) who underwent hysterectomy without prophylactic balloon occlusion over the past four years (January 2016–November 2019). Results Significantly lower intraoperative blood loss (2.8 L vs. 4.7 L; P = 0.048) and pure red blood cell (PRBC) requirement ( P = 0.026) between patients who had hysterectomy with and without interventional radiological management was observed. Significantly higher blood loss ( P = 0.006) and fluid requirement ( P = 0.007) was observed with a higher degree of placental invasion. Only 1 (6%) major procedure-related complication was observed. Conclusion Interventional radiological procedures are effective in significantly reducing intraoperative blood loss and blood product requirement in patients with PAS.
Supera stent placement for salvage of dialysis AVF between December 2016 to July 2018. Nine patients had brachiocephalic fistula and 2 patients had brachiobasilic fistula. Patients presented with fistula thrombosis (n=8) and dysfunction (n=3). Lesions were distributed along the venous outflow including the cephalic arch (n=5) and juxta-anastomotic needling segment (n=6). Evaluated outcomes included technical success, primary stent and circuit patency. Other outcomes were time to reintervention and secondary patency. Result(s): Technical success was (100%). One stent stretched into the access sheath and was successfully removed through the puncture site, and a new stent was successfully deployed. Three patients required additional stent grafts at other sites during the index procedure. No major complications. Fistula function was restored in all patients with no additional interventions for a mean time of 242 days (50-734 days). Seven patients required re-intervention at mean time of 131 days (50-262 days). Reasons for re-interventions included inflow stenosis (n=5), outflow stenosis (n=1) and in-stent stenosis (n=1). Seven fistulas remain patent at mean follow up time of 484 days (136-734 days). Conclusion(s): Supera stent placement in AVF stenosis refractory to balloon angioplasty is technically feasible and may be effective in maintaining fistula function. Further evaluation of this technique requires larger randomized studies.
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