Radiologic Intervention of Internal Iliac Artery Occlusion During Cesarean Section for Dangerous Placenta Previa

Objective: The cesarean section of dangerous placenta previa always faces the problem of massive hemorrhage. The aim of this study was to analyze the clinical effect of internal iliac artery occlusion combined with obstetric autotransfusion in cesarean section of dangerous placenta previa. Method: From November 2017 to November 2019, 20 patients with placenta previa undergoing cesarean section in our hospital were selected. According to the preoperative MRI and ultrasound diagnosis, the amount of bleeding was evaluated and divided into observation group (n = 6) and control group (n = 14). All patients underwent routine cesarean section and prepared the obstetric autotransfusion device. In the observation group, the internal iliac artery balloon was placed under DSA before operation. After the fetus was taken out, the internal iliac artery was blocked. The internal iliac artery occlusion was not needed in the control group. The total length of stay, Apgar score, the incidence of disseminated intravascular coagulation (DIC), hemorrhagic shock, postoperative infection and renal dysfunction were compared between the two groups. Result: Compared with the relative data in control group, the operation time and postoperative hospital stay of the observation group were significantly shorter, the intraoperative blood loss and blood transfusion were significantly lesser, and the hemoglobin difference before and after operation was significantly lesser. There was no significant difference in the incidence of DIC, hemorrhagic shock, postoperative infection and renal dysfunction between two groups; There was no significant difference in neonatal body mass, Apgar score at 1 min and 5 min. Conclusion: The internal iliac artery occlusion can effectively reduce the amount of bleeding in delivery, promote the recovery of negligence, and have no adverse effect on complications and neonatal outcome.

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Effect of prophylactic balloon occlusion of internal iliac artery in pregnancies complicated by placenta previa and accreta

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04103-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daijuan Chen ◽

Jinfeng Xu ◽

Yuan Tian ◽

Pengfei Ye ◽

Fumin Zhao ◽

...

Keyword(s):

Iliac Artery ◽

Subgroup Analysis ◽

Internal Iliac Artery ◽

Placenta Previa ◽

Massive Hemorrhage ◽

Balloon Occlusion ◽

Control Group ◽

Significant Difference ◽

Hospitalization Costs ◽

Internal Iliac

Abstract Background Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic balloon occlusion of the internal iliac artery (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta. Methods A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n = 248) and the control group in which patients did not have PBOIIA (n = 172). Meanwhile, we performed a subgroup analysis in whether taking parallel transverse uterine incision (PTUI) surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected. Results Median estimated blood loss (mEBL) was 2200 mL in the balloon group and 2150 mL in the control group respectively, there was no significant difference between two-groups comparison (P > 0.05), and the rate of patients with hysterectomy was also has no difference between the two groups (36.3% verus 35.5%, P > 0.05), while there is a significant difference between two groups in the amount of PRBCs transfused [3 (0–31.5) verus 3 (0–39), P <0.05], moreover, the proportion of PRBCS> 8 units in the balloon group is significantly lower than that in control group (11.29% verus 23.26%, P <0.05).. However, the total hospitalization costs (45,624.4 ± 11,061.9 verus 37,523.1 ± 14,662.2, CYN) and surgery costs (19,910.6 ± 2622.6 verus 11,850.5 ± 3146.1, CYN) in balloon group were significantly higher than those in control group (P < 0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL (P >0.05), but it could significantly decrease hysterectomy rates (P <0.05). Conclusions PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta. and although it could reduce the intraoperative PRBCs in patients with massive hemorrhage, it significantly increases the financial cost for patients. Therefore, PBOIIA should not be routinely recommended to patients with placenta previa and accreta.

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Effect of prophylactic interventional therapy of internal iliac artery balloon occlusion in pregnancies complicated by placenta previa and accreta: a retrospective cohort study

10.21203/rs.3.rs-199296/v1 ◽

2021 ◽

Author(s):

Daijuan Chen ◽

Jinfeng Xu ◽

Yuan tian ◽

Pengfei Ye ◽

Fumin Zhao ◽

...

Keyword(s):

Iliac Artery ◽

Subgroup Analysis ◽

Internal Iliac Artery ◽

Placenta Previa ◽

Interventional Therapy ◽

Balloon Occlusion ◽

Control Group ◽

Significant Difference ◽

Hospitalization Costs ◽

Internal Iliac

Abstract Background: Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage, the prophylactic intravascular balloon occlusion technique is increasingly used in managing uncontrolled hemorrhage in cesarean section (CS). We aim to examine the clinical effectiveness of prophylactic interventional therapy of the internal iliac artery balloon occlusion (PBOIIA) during CS in improving maternal outcomes for patients with placenta previa and accreta. Methods: A total of 420 women with placenta previa and accreta who underwent CS from January 2014 to December 2018 were included retrospectively. Patients were divided into balloon group in which patients had PBOIIA (n=248) and the control group in which patients did not have PBOIIA (n=172). Meanwhile, we performed a subgroup analysis in whether taking PTUI surgery. Information on conditions of patients and newborns, perioperative blood indicators, surgical outcomes were collected.Results: Median estimated blood loss (mEBL) was 2200mL in the balloon group and 2150mL in the control group respectively, there was no significant difference between two-groups comparison (P＞0.05). The rate of patients with hysterectomy (36.3% verus 35.5%) and amount of PRBCs transfused [(0-31.5) verus 3 (0-39)] were not different between two groups (P＞0.05). However, the total hospitalization costs (7044.4±1708.0 verus 5793.6±2263.8) and surgery costs (3074.2±404.9 verus 1829.7±485.8) in balloon group were significantly higher than those in control group (P<0.05). Subgroup analysis showed PTUI surgery had no significant differences in EBL ((P＞0.05), but it could significantly decrease hysterectomy rates (P＜0.05).Conclusions: PBOIIA has no significant effect on reducing intraoperative EBL and hysterectomy rate in patients with placenta previa and accreta, but it significantly increases the financial cost for patients. PBOIIA should not be routinely recommended to patients with placenta previa and accreta.

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Internal iliac artery revascularisation versus internal iliac artery occlusion for endovascular treatment of aorto-iliac aneurysms

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd013168 ◽

2018 ◽

Author(s):

Luiz Henrique DG Sousa ◽

Jose CC Baptista-Silva ◽

Vladimir Vasconcelos ◽

Ronald LG Flumignan

Keyword(s):

Endovascular Treatment ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Artery Occlusion ◽

Iliac Artery Occlusion ◽

Internal Iliac

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Impact of Intermittent Functional Internal Iliac Artery Occlusion on Spinal Cord Blood Supply During TEVAR

Journal of Vascular Surgery ◽

10.1016/j.jvs.2019.06.098 ◽

2019 ◽

Vol 70 (3) ◽

pp. 1009-1010

Author(s):

S. Maier ◽

J. Morlock ◽

C. Benk ◽

F.A. Kari ◽

M. Siepe ◽

...

Keyword(s):

Spinal Cord ◽

Cord Blood ◽

Blood Supply ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Artery Occlusion ◽

Iliac Artery Occlusion ◽

Internal Iliac ◽

Spinal Cord Blood Supply

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

American Journal of Roentgenology ◽

10.2214/ajr.07.2417 ◽

2007 ◽

Vol 189 (5) ◽

pp. 1158-1163 ◽

Cited By ~ 116

Author(s):

Cher Heng Tan ◽

Kiang Hiong Tay ◽

Kenneth Sheah ◽

Kenneth Kwek ◽

Kenneth Wong ◽

...

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Placenta Accreta ◽

Artery Occlusion ◽

Iliac Artery Occlusion ◽

Occlusion Balloon ◽

Internal Iliac

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Prophylactic Internal Iliac Artery Occlusion Balloon Placement to Reduce Operative Blood Loss in Patients with Invasive Placenta

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2017.08.015 ◽

2018 ◽

Vol 29 (2) ◽

pp. 219-224 ◽

Cited By ~ 16

Author(s):

Andrew C. Picel ◽

Brent Wolford ◽

Rory L. Cochran ◽

Gladys A. Ramos ◽

Anne C. Roberts

Keyword(s):

Blood Loss ◽

Iliac Artery ◽

Internal Iliac Artery ◽

Artery Occlusion ◽

Operative Blood Loss ◽

Iliac Artery Occlusion ◽

Occlusion Balloon ◽

Internal Iliac ◽

Invasive Placenta

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The Clinical Evaluation of IIA Balloon Occlusion for Pernicious Placenta Previa Patients with Placenta Accreta: A Retrospective Study

10.21203/rs.3.rs-900376/v1 ◽

2021 ◽

Author(s):

Ling Hong ◽

Aner Chen ◽

Jinliang Chen ◽

Xiuxiu Li ◽

Wenming Zhuang ◽

...

Keyword(s):

Blood Loss ◽

Iliac Artery ◽

Caesarean Delivery ◽

Internal Iliac Artery ◽

Placenta Accreta ◽

Placenta Previa ◽

Balloon Occlusion ◽

Control Group ◽

Estimated Blood Loss ◽

Internal Iliac

Abstract Objective: This study aimed to evaluate the clinical efficacy of internal iliac artery(IIA) balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta. Background: Pernicious placenta previa is frequently reported to be complicated with placenta accreta, which contributes to serious consequences such as severe obstetric postpartum hemorrhage or even maternal mortality. Methods: Fifty-eight pernicious placenta previa patients complicated with placenta accreta were retrospectively reviewed. The ballon group consisted of 23 patients, who underwent a caesarean delivery with internal iliac artery occlusion. 35 patients were in the control group, who had a standard caesarean delivery. The primary outcomes were estimated blood loss (EBL), cesarean hysterectomy, and blood transferring volume. The secondary outcomes were operating time, intraoperative hemostatic approaches, surgical complications, balloon catheter–related complications, length of maternal stay, cost of hospitalization, and neonatal outcomes.Results: No difference was observed in estimated blood loss (EBL), blood transferring percentages and volume, additional measures to secure hemostasis , surgical complications, hospital stay postoperatively and newborn outcomes. More than 40% of the balloon group underwent hysterectomy because of uncontrollable postpartum bleeding (10[43.48%] vs. 11[31.43%],P=0.350).Complications related to occlusion of IIA did not occur.The duration of the surgery of the balloon group was significantly longer than that of the control group(123.52 min±74.76 versus 89.17±48.68,P=0.038), and the total hospitalization cost was also significantly higher than that of the control group(45116.67±9358.67 yuan versus 30615.41±11587.44yuan,P=0.000).Conclusion: IIA balloon occlusion in patients with pernicious placenta previa coexisting with placenta accreta did not reduce the hysterectomy rate during cesarean section, nor did it reduce blood loss and blood transfusion, but it prolonged the duration of the surgery and increased the total cost.

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