Aberrant Right Ovarian Artery from Proximal Internal  Iliac Artery in Uterine Artery Embolization Patient

Purpose The objective of the study was to evaluate the efficacy and safety of combined prophylactic intraoperative internal iliac artery balloon occlusion and postoperative uterine artery embolization in the conservative management (uterine preservation) of women with invasive placenta undergoing scheduled caesarean delivery. Methods Ten women (mean age 35 years) with invasive placenta choosing caesarean delivery without hysterectomy had preoperative insertion of internal iliac artery occlusion balloons, intraoperative inflation of the balloons, and immediate postoperative uterine artery embolization with absorbable gelatin sponge. A retrospective review was performed with institutional review board approval. Outcome measures were intraoperative blood loss, transfusion requirement, hysterectomy rate, endovascular complications, surgical complications, and postoperative morbidity. Results All women had placenta increta or percreta, and concomitant complete placenta previa. Mean gestational age at delivery was 36 weeks. In 6 women the placenta was left undisturbed in the uterus, 2 had partial removal of the placenta, and 2 had piecemeal removal of the whole placenta. Mean estimated blood loss during caesarean delivery was 1.2 L. Only 2 patients (20%) required blood transfusion. There were no intraoperative surgical complications, endovascular complications, maternal deaths, or perinatal deaths. Three women developed postpartum complications necessitating postpartum hysterectomy; the hysterectomy rate was therefore 30% and uterine preservation was successful in 70%. Conclusion Combined bilateral internal iliac artery balloon occlusion and uterine artery embolization may be an effective strategy to control intraoperative blood loss and preserve the uterus in patients with invasive placenta undergoing caesarean delivery.

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Analysis of Related Influencing Factors of Hysterectomy in Patients With Placenta Accreta Spectrum Disorders After Uterine Artery Embolization

10.21203/rs.3.rs-103137/v1 ◽

2020 ◽

Author(s):

Duzhou Zheng ◽

Huawei Shen ◽

Mingxing Liu ◽

Shikuan Huang ◽

Weifeng Liu ◽

...

Keyword(s):

Risk Factors ◽

Iliac Artery ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Placenta Accreta ◽

Artery Embolization ◽

Ovarian Artery ◽

Placenta Accreta Spectrum ◽

Independent Risk Factors ◽

Collateral Vessels

Abstract Objective: To estimate the related factors of hysterectomy in patients with Placenta accreta spectrum (PAS) after uterine artery embolization (UAE), and try to evaluate the effectiveness and safety of UAE in patients with PAS.Methods: From January 2012 to July 2020, a retrospective analysis was performed in 85 patients undergoing TAE for PAS. Information regarding clinical data, angiography as well as embolization details, and clinical outcomes was obtained. Univariate and multivariate analyses were performed to determine the factors related to hysterectomy.Results: Bleeding greater than or equal to 500ml during the delivery(p = 0.037), the placenta type by MR or US(placenta increta vs placenta percreta, P = 0.01) and the type of ovarian artery(No vs Bilateral, P = 0.005; Unilateral vs Bilateral, P = 0.01) were independent risk factors of hysterectomy in PAS patients treated with UAE. The area under the curve (AUC) of the predictive model that incorporated the independent risk factors was 0.844. Abnormal collateral vessels communicating with uterine artery were observed on angiography in 24 patients (28.2%) with 31 abnormal collateral vessels. The major abnormal collateral vessel was the abnormal branches of the internal iliac artery(n = 13), followed by the inferior vesical artery (n = 11), internal pudendal artery(n = 3), obturator artery (n = 2), vaginal artery(n = 1) and the abnormal branches of the external iliac artery(n = 1).Conclusions: TAE is safe and effective for patients with PAS. Bleeding greater than or equal to 500ml during the delivery, the placenta type by MR or US and the type of ovarian artery were related to the hysterectomy. For patients with hypertrophic ovarian-uterine artery anastomosis and no fertility requirements, Ovarian artery embolization(OAE) could be a feasible choice.

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