Prophylactic abdominal aortic balloon occlusion: An effective method of controlling hemorrhage in patients with placenta previa or accreta

Abstract

Postpartum hemorrhage is considered to be a serious complication in patients with pernicious placenta. Approaches employing abdominal aortic balloon occlusion to control hemorrhage are extremely effective for such patients. The present study analyzed 9 patients with pernicious placenta previa in a single hospital from June 2016 to November 2017. Prior to cesarean hysterectomy, an abdominal aortic balloon catheter was placed in all patients. The balloon was inflated and evacuated alternately using saline following delivery of the fetal head. The X-ray dose, bleeding volume and complications during the procedure were observed. Balloon catheterization was successfully performed in all 9 patients. The dose of X-rays ranged from 15.8 to 24.5 mGy, with a mean of 19.3±2.7 mGy; the volume of blood loss ranged from 50 to 4,000 ml, with a mean of ~1,800 ml. Uterine artery embolization was successfully performed in 2 cases due to bleeding following the cesarean hysterectomy, and every uterus was retained. Abdominal aortic balloon occlusion can effectively reduce the amount of bleeding during cesarean hysterectomy in patients with pernicious placenta previa. This may serve as technical support for patients in whom retention of the uterus is expected. However, it is necessary to identify any abnormal uterine tissue above the level of the renal artery in order to avoid ineffective balloon occlusion. Patients and methodsPatients. The present retrospective study was conducted among women with pernicious placenta previa accreta/increta who were treated in The First Affiliated Hospital of Anhui Medical

The application of prophylactic balloon occlusion of the internal iliac artery for the treatment of placenta accreta spectrum with placenta previa: a retrospective case-control study

“…The complications after vascular embolisation also remain controversial and may include ischaemic necrosis of the lower limbs, thrombosis of the internal iliac artery, haematoma at the puncture site, ischaemia-reperfusion injury of tissues and organs and acute renal failure, among others. Iliac artery thrombosis has been reported to be the most common complication, with a risk of approximately 5% [44,46,47], which may be due to changes in maternal blood flow, vascular injury during puncture and the hypercoagulable state of blood during pregnancy [46]. One patient developed lower limb thrombosis on the first day after balloon occlusion of the internal iliac artery in our hospital after internal iliac artery embolisation.…”

Outcomes of prophylactic abdominal aortic balloon occlusion in patients with placenta previa accreta: a propensity score matching analysis

“…It may cause complications, including initial vessel injury, arterial thrombosis, puncture point haematoma, ischaemic necrosis of the lower limbs, reperfusion injury of tissues and organs, acute renal failure and rarely artery rupture [ 10 – 12 , 28 ]. It was reported that measurement of the abdominal aortic diameter before the intervention, clearance of the opening of the renal artery and control of the duration of balloon occlusion are essential for decreasing the risk of complications [ 29 ]. In our study, the diameter of the abdominal aorta was measured by MRI before surgery to determine the appropriate size of the balloon catheter.…”

Outcomes of balloon occlusion in the University of California Morbidly Adherent Placenta Registry

“…34,35 In our study there were no apparent complications resulting directly from the use of occlusive balloons, although we note that there have Original Research been previous reports of ischemic necrosis of the lower limbs, arterial thrombosis, and initial vessel injury secondary to balloon placement. 36,37 Results in the context of prior studies…”