Prolonged balloon occlusion of the lower abdominal aorta during pelvic or sacral tumor resection

Object Pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection. Methods The authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies. Results Twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°). Conclusions The PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy.

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Efficacy of Precesarean Infrarenal Abdominal Aorta Balloon Occlusion Among Women With Pernicious Placenta Previa and Placenta Accreta: A Retrospective Cohort Analysis

10.21203/rs.3.rs-919396/v1 ◽

2021 ◽

Author(s):

Xuemin Wei ◽

Yan Chen ◽

Weiwei Cheng

Keyword(s):

Blood Loss ◽

Abdominal Aorta ◽

Placenta Accreta ◽

Placenta Previa ◽

Balloon Occlusion ◽

Neonatal Outcomes ◽

Control Group ◽

Study Group ◽

Estimated Blood Loss ◽

Infrarenal Abdominal Aorta

Abstract Purpose To evaluate the efficacy and safety of prophylactic balloon occlusion of the infrarenal abdominal aorta among women with pernicious placenta previa and placenta accreta.Methods This retrospective study included 110 patients with pernicious placenta previa and placenta accreta. The control group consisted of 55 patients who underwent cesarean section alone, and the study group included 55 patients who underwent precesarean prophylactic balloon occlusion of the infrarenal abdominal aorta. In addition, both of the groups were further divided according to FIGO clinical grading standards. Prevention of hysterectomy was the primary outcome evaluated. The secondary outcomes included operative duration, estimated blood loss, blood transfusion, intensive care unit admission, total hospital stay (days), and puerperal morbidity, and these data were compared between the two groups. Additionally, the neonatal outcomes were compared.Results There were no significant differences in maternal and neonatal outcomes in the PAS 2 and PAS 3 groups (P > 0.05). However, in the PAS 4 and PAS 5 groups, the amount of bleeding in the study group was significantly less than that in the control group (3533.3 ± 2391.4 vs 4293.6 ± 1235.4, P < 0.05), and the total hysterectomy rate was also lower (7.8% vs 13.2%, P < 0.05).Conclusion Precesarean infrarenal abdominal aortic balloon occlusion is an effective and safe option for treating pernicious placenta previa and placenta accreta and can effectively reduce the risk of hysterectomy and intraoperative blood loss in women with PAS grade 4-5.

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The effect and long-term outcome of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion on the patients with placenta percreta

10.21203/rs.3.rs-31115/v1 ◽

2020 ◽

Author(s):

Huidan Zhao ◽

Chen Chen ◽

Ya Tao ◽

Zhuan Liu ◽

Cai Liu ◽

...

Keyword(s):

Blood Loss ◽

Abdominal Aorta ◽

Operation Time ◽

Balloon Occlusion ◽

Placenta Percreta ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

The Mean

Abstract Background Patients with placenta accreta spectrum (PAS) disorders often experience overwhelming hemorrhage during cesarean. Placenta percreta is the most serious subtype. In this paper, we propose a new procedure in order to control intraoperative bleeding. We aimed to evaluate the effect and long-term outcome of Partial Anterior Myometrial Resection and Reconstruction under tourniquet and/or prophylactic abdominal aorta balloon occlusion on patients with placenta percreta. Methods In a retrospective study, data from patients with placenta percreta who delivered by cesarean section between January 1, 2017 and December 31, 2019 were analyzed. Short-term and long-term outcomes were followed up by outpatient clinic and by phone. The quantity of estimated blood loss (EBL), operation time, urine tube time, hospital stay and short-term and long-term complications including fever, thrombosis, hematoma, breast feeding and menstruation problems, lower limb complaints, intrauterine adhesion and so on, were analyzed. Results For all cases, the mean EBL in the surgery was 1399 ± 948 mL, the mean operation time was 107 ± 35minutes, and the mean perioperative hospital stay was 9.6 ± 5.0 days. All the patients had a preserved uterus. Menstrual quantity decreased in 12 patients. Menstrual period prolonged in 11 cases. Uncomfortable abdomen symptoms happened in 9 cases after the surgery. Four cases got thrombosis and 3 got hematoma. Lower extremity discomfort was found in 6 patients. Conclusion Combined with prophylactic abdominal aorta balloon occlusion and/or tourniquet, Partial Anterior Myometrial Resection and Reconstruction is highly effective in reducing the intraoperative blood loss and hysterectomy in placenta percreta. But we should pay great attention to short-term and long-term complications, especially to the complications associated with aorta balloon occlusion.

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