Intraoperative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement during Cesarean Hysterectomy for Placenta Accreta Spectrum - PubMed (original) (raw)

Intraoperative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement during Cesarean Hysterectomy for Placenta Accreta Spectrum

Zachary T Berman et al. J Vasc Interv Radiol. 2023 Nov.

Abstract

Purpose: To evaluate the effectiveness and safety of prophylactic multivessel selective embolization (MVSE) compared to those of internal iliac artery occlusion balloon (IIABO) placement in patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS).

Materials and methods: An institutional review board-approved retrospective series was conducted with consecutive patients with PAS at a single institution between 2010 and 2021. MVSE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries, which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring transfusion, and adverse events were recorded.

Results: A total of 20 patients treated with embolization and 34 patients with balloon placement were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss in the MVSE group was 713 mL (interquartile range [IQR], 475-1,000 mL) compared to 2,000 mL (IQR, 1,500-2,425 mL) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and percentage of cases requiring a transfusion (20% vs 65%) were less in the MVSE group (P < .01). A median of 4 vessels (IQR, 3-9) were embolized during MVSE. No major adverse events or nontarget embolization consequences were observed.

Conclusions: Prophylactic MVSE is a safe procedure that reduces operative blood loss and transfusion requirements compared to those of IIABO in patients undergoing cesarean hysterectomy for presumed higher-degree PAS.

Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.

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Figures

Figure 1.

Figure 1.

Representative digital subtraction angiograms of a postpartum patient after cesarean section with placenta accreta. (a) Abdominal aortogram portrayed extensive hypervascularity with irregular tangles of vessels. (b) Left uterine arteriogram confirmed typical postpartum hypertrophy, redundancy, and irregularity of vessels. (c) Left superior vesicular arteriogram demonstrated placental supply (arrows) with venous pooling (arrowheads). (d) Left inferior epigastric arteriogram depicted the tortuous and redundant round ligament artery (bracket), leading to parenchymal blush of the placenta (arrows). (e) Arteriogram of the right deep circumflex iliac artery (arrow) revealed a parasitized branch supplying the placenta (arrowheads). (f) Final abdominal aortogram after multiple selective embolizations demonstrated marked reduction in the hypervascularity. However, there was a notable increased vasospasm of the bilateral external iliac arteries, occluding flow on the right (arrowhead). The ovarian arteries were spared (not depicted).

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