title: Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta.
abstract: The increasing incidence of morbidly adherent placenta (MAP) is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic iliac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal iliac artery balloons who had external iliac artery thrombosis detected by computed tomography angiography (CTA) 72 h post cesarean section. A digital subtraction angiogram (DSA) and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic iliac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China.
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Lou
authors.affiliation: Department of Interventional Oncolog, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China.
authors.forename: Xue-Bin
authors.initials: XB
authors.lastname: Zhang
authors.affiliation: Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Jia-Ning
authors.initials: JN
authors.lastname: Fu
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China.
authors.forename: Yun-Yan
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China.
authors.forename: Zhi-Guo
authors.initials: ZG
authors.lastname: Zhuang
authors.affiliation: Department of Obstetrics and Gynecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200126, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Lin
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion / Q000009:adverse effects*; D001777:Blood Coagulation; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002404:Catheterization; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D061330:Multidetector Computed Tomography; D010920:Placenta / Q000601:surgery; D010921:Placenta Accreta / Q000601:surgery*; D011247:Pregnancy; D015912:Thrombolytic Therapy / Q000379:methods*; D014652:Vascular Diseases
keywords: Balloon catheter; Internal iliac artery; Interventional thrombolysis; Placenta accrete; Vascular complication