Intraoperative Use of Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhage Control in Woman with Placenta Percreta Involving the Bladder

Abstract

A 42-year-old woman with irregular uterine contractions and a history of two prior cesarean sections was admitted. At 35 weeks of gestation, preterm labor with vaginal bleeding led to a cesarean section. During placenta removal it was revealed to be a percreta and uncontrollable massive bleeding ensued. Intraoperative resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed, which has been used as a resuscitative adjunct for trauma patients with noncompressible torso hemorrhage and a hysterectomy was successfully completed. Gauze packing for temporary abdominal closure and angio-embolization were performed to further control bleeding. The packed gauze was removed 2 days later and the patient recovered uneventfully. To the best of our knowledge, this is the first reported case in South Korean literature of the successful application of a REBOA as a salvage treatment for hemorrhage control, and REBOA could be a life-saving procedure for patients with peripartum hemorrhaging.

Aortic balloon occlusion in distal zone 3 reduces blood loss from obstetric hemorrhage in placenta accreta spectrum

“… 17 Not unlike blood flow in patients with aorto-iliac occlusive disease, flow through collateral pathways is significantly augmented during term pregnancy to meet the demands of the uterus, placenta, and fetus. Chang and colleagues 18 describe the case of a PAS patient with persistent bleeding during a cesarean hysterectomy despite proximal zone 3 aortic occlusion and surgical ligation of the left iliac artery. They obtained an angiogram with the balloon inflated to visualize the source of hemorrhage, and the extensive collateral circulation can be well seen (Supplemental Digital Content, Supplementary Fig.…”

Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience

“…The treatment paradigm has shifted with advancements JCS in endovascular treatment methods [11]. REBOA has recently been used as an alternative to RT-ACC in traumatic shock patients with subdiaphragmatic hemorrhage [8,10,[12][13][14] as well as to treat hemorrhagic shock in non-trauma patients [15][16][17]. Furthermore, REBOA kits have been accepted as essential equipment in trauma bays and emergency rooms for the resuscitation of patients with traumatic shock [10].…”

Resuscitative Endovascular Balloon Occlusion of the Aorta for an Iliac Artery Aneurysm: Case Report

“…REBOA has been accepted as a technique for preoperatively reducing hemorrhage and increasing cerebral/coronary perfusion in patients with non-compressible torso hemorrhage (NCTH) [5][6][7]. Recently, its use has expanded beyond just trauma care to encompass other types of bleeding or resuscitation for hemodynamic stabilization [5][6][7][8]. In general, different occlusion zones in the aorta could be used to block blood flow to the lower body with the following classification and indications: zone I REBOA (descending thoracic aorta, from the origin of the left subclavian artery to the celiac artery) for patients with hemoperitoneum and/or retroperitoneal hemorrhage and zone III REBOA (infrarenal abdominal aorta, from the renal artery to the aortic bifurcation) for patients with pelvic bleeding.…”