Prophylactic balloon-occlusion of the hypogastric arteries in surgical treatment placenta accreta spectrum disorders: how we do it

Abstract

Placenta accreta spectrum disorders are amongst the most dangerous conditions associated with pregnancy which can lead to massive obstetric hemorrhage and, secondarily, to coagulopathy, multisystem organ failure and maternal death. Peri-operative endovascular balloon occlusion of the pelvic vessels has been shown to be effective in reducing estimated blood loss, transfusion requirements, and in providing favorable surgical conditions, with low procedure-related complications, highlighting the importance of practicing interventional radiologists to understand the indications and technical considerations in the use of occlusion balloons in this scenario. Nevertheless, the optimal position of occlusion balloon catheters placement is still controversial and protocols differ between institutions and local expertise. Using a case of placenta increta as example, this report provides detailed description of the technical details and materials used in our Center for pre-operative Prophylactic Balloon-Occlusion of the Hypogastric Arteries (our preferred approach), from the angio suite until completion of hysterectomy.