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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.

介入溶栓成功治愈预置球囊术在凶险性前置胎盘应用中诱发的动脉血栓

[1]Bishop, S., Butler, K., Monaghan, S., et al., 2011. Multiple complications following the use of prophylactic internal iliac artery balloon catheterisation in a patient with placenta percreta. Int. J. Obstet. Anesth., 20(1):70-73.

[2]Bodner, L.J., Nosher, J.L., Gribbin, C., et al., 2006. Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta. Cardiovasc. Intervent. Radiol., 29(3):354-361.

[3]Carnevale, F.C., Kondo, M.M., de Oliveira Sousa, W., et al., 2011. Perioperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta. Cardiovasc. Intervent. Radiol., 34(4):758-764.

[4]Chou, M.M., Kung, H.F., Hwang, J.I., et al., 2015. Temporary prophylactic intravascular balloon occlusion of the common iliac arteries before cesarean hysterectomy for controlling operative blood loss in abnormal placentation. Taiwan J. Obstet. Gynecol., 54(5):493-498.

[5]Dubois, J., Garel, L., Grignon, A., et al., 1997. Placenta percreta: balloon occlusion and embolization of the internal iliac arteries to reduce intraoperative blood losses. Am. J. Obstet. Gynecol., 176(3):723-726.

[6]Greenberg, J.I., Suliman, A., Iranpour, P., et al., 2007. Prophylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary case. Am. J. Obstet. Gynecol., 197(5):470.e1-470.e4.

[7]Matsueda, S., Hidaka, N., Kondo, Y., et al., 2015. External iliac artery thrombosis after common iliac artery balloon occlusion during cesarean hysterectomy for placenta accreta in cervico-isthmic pregnancy. J. Obstet. Gynaecol. Res., 41(11):1826-1830.

[8]Paull, J.D., Smith, J., Williams, L., et al., 1995. Balloon occlusion of the abdominal aorta during caesarean hysterectomy for placenta percreta. Anaesth. Intens. Care, 23(6):731-734.

[9]Royal College of Obstetricians and Gynaecologists, Royal College of Radiologists, British Society of Interventional Radiology, 2007. The Role of Emergency and Elective Interventional Radiology in Postpartum Haemorrhage. (Good Practice Guidance No. 6). Royal College of Obstetricians and Gynaecologists.

[10]Royal College of Radiologists, British Society of Interventional Radiology, 2007. Achieving Standards in Vascular Radiology. Royal College of Radiologists, London.

[11]Sewell, M.F., Rosenblum, D., Ehrenberg, H., 2006. Arterial embolus during common iliac balloon catheterization at cesarean hysterectomy. Obstet. Gynecol., 108(3 Pt 2):746-748.

[12]Shrivastava, V., Nageotte, M., Major, C., et al., 2007. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accreta. Am. J. Obstet. Gynecol., 197(4):402.e1-402.e5

[13]Teixidor Vinas, M., Chandraharan, E., Moneta, M.V., et al., 2014. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta. Clin. Radiol., 69(8):e345-e351.