title: Prophylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary case.
abstract: Massive hemorrhage from abnormal placentation is a leading cause of postpartum maternal death and hysterectomy after cesarean section. The endovascular surgeon and radiologist are increasingly asked to assist in the management of these complex patients with the placement of bilateral internal iliac artery balloon catheters. We report the case of a 27-year-old woman with placenta percreta with preemptive bilateral internal iliac artery balloons who had iliac artery thrombosis and acute limb ischemia develop 7 hours after cesarean hysterectomy. This is the first report of iliac artery thrombosis in this setting. A review of the vascular and obstetrical literature reveals divergent recommendations for the use of this technique in patients with abnormal placentation. No guidance from rigorous prospective evidence is available and thus we offer recommendations for the cautious use of this modality.
authors.affiliation: Section of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, School of Medicine, San Diego, CA 92103, USA.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Greenberg
authors.forename: Ahmed
authors.initials: A
authors.lastname: Suliman
authors.forename: Pooya
authors.initials: P
authors.lastname: Iranpour
authors.forename: Niren
authors.initials: N
authors.lastname: Angle
mesh_terms: D000328:Adult; D000465:Algorithms; D016063:Blood Loss, Surgical; D002404:Catheterization; D005260:Female; D006400:Hematocrit; D006406:Hematoma; D006801:Humans; D007044:Hysterectomy; D007083:Iliac Artery; D008279:Magnetic Resonance Imaging; D010921:Placenta Accreta / Q000175:diagnosis / Q000628:therapy*; D006473:Postpartum Hemorrhage / Q000209:etiology; D011247:Pregnancy; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed