Ligation or Occlusion of the Internal Iliac Arteries for the Treatment of Placenta Accreta Spectrum: Why Is This Technique Still Performed?

Nieto-Calvache, Albaro José; Palacios-Jaraquemada, José M.; Aryananda, Rozi Aditya; Basanta, Nicolás; Burgos-Luna, Juan Manuel; Rodriguez, Fernando; Ordoñez, Carlos; Sarria-Ortiz, Daniela; Muñoz-Córdoba, Laura; Quintero, Juan Carlos; Galindo-Velasco, Valentina; Messa-Bryon, Adriana

doi:10.1097/fm9.0000000000000195

Cited by 2 publications

(9 citation statements)

References 43 publications

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“…The terminal branches of the deep circumflex iliac artery anastomose with the terminal branch of the superior gluteal and fourth lumbar arteries, providing a sys- The third group comprises anastomoses between most divisions of the large vessels in the pelvis, including the IIA, external iliac, femoral arteries, and divisions of the abdominal aorta (fourth lumbar artery). There is some debate among authors regarding the significance of the divisions from the external iliac artery in IIA ligation, with some suggesting they have no role, while others argue the opposite [5,6,62]. However, it is essential not to overlook anastomoses originating from the external iliac or femoral arteries after IIA ligation.…”

Section: Anastomoses In the Pelvis And Their Relation To Iia Ligationmentioning

confidence: 99%

“…The indications for IIA ligation can be prophylactic or therapeutic in both gynecological and obstetrical situations [ 5 , 30 , 31 , 32 ]. The need for IIA ligation arises from increased intrabdominal bleeding recognized before, during, or after surgery.…”

Section: Indications For Iia Ligationmentioning

confidence: 99%

“…IIA ligation is a potentially lifesaving procedure in cases of severe bleeding in obstetrics and gynecology [ 3 , 4 , 5 , 6 , 7 ]. In 1894, Howard Kelly was the first to introduce this procedure.…”

Section: Introductionmentioning

confidence: 99%

“…He ligated both internal iliac arteries and ovarian arteries to control pelvic bleeding when he failed to perform a hysterectomy for patients with advanced cervical cancer [ 4 ]. Immediately after the procedure, he observed the cessation of the pelvic hemorrhage and regression of the carcinoma in the following months [ 4 , 5 ]. Hence, the indications of IIA ligation have expanded [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the procedure has never been widely practiced, it remains one of the treatment methods to manage profuse pelvic hemorrhage in obstetrics [ 7 ]. Surgeons are often reluctant to perform the procedure due to concerns about potential complications, such as buttock claudication, impotence, and urinary bladder and rectum necroses [ 1 , 5 , 7 ]. Contemporary practice increasingly favors alternatives such as selective arterial embolization or temporary balloon occlusion, which can be employed preoperatively or intraoperatively in cases of severe genital or pelvic bleeding [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Internal Iliac Artery Ligation in Obstetrics and Gynecology: Surgical Anatomy and Surgical Considerations

Kostov,

Kornovski,

Watrowski

et al. 2023

Clinics and Practice

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The internal iliac artery (IIA) is the main arterial vessel of the pelvis. It supplies the pelvic viscera, pelvic walls, perineum, and gluteal region. In cases of severe obstetrical or gynecologic hemorrhage, IIA ligation can be a lifesaving procedure. Regrettably, IIA ligation has not gained widespread popularity, primarily due to limited surgical training and concerns regarding possible complications, including buttock claudication, impotence, and urinary bladder and rectum necroses. Nowadays, selective arterial embolization or temporary balloon occlusion are increasingly utilized alternatives, which can be applied preoperatively or intraoperatively for threatening severe genital or pelvic bleeding. However, IIA ligation retains its relevance, as the previously described procedures are not always available and have limitations. This article provides a step-by-step guide to the IIA ligation procedure and its possible complications. It also includes a detailed description of the anatomy of the IIA and pelvic arterial anastomoses. This review highlights the importance of a thorough understanding of pelvic anatomy as a prerequisite for safe IIA ligation and posits that training in this procedure should be an integral part of obstetrics and gynecology curricula.

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Section: Anastomoses In the Pelvis And Their Relation To Iia Ligationmentioning

confidence: 99%