Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysis

Iliac artery rupture related to balloon insertion for placenta accreta causing maternal hemorrhage and neonatal compromise

“…4 Since then, multiple reports examining the use of these balloons have been published. 3 The rate of complications related to the procedure has been estimated to be 6-15.8%. 5 Minor complications include subcutaneous hematoma formation or transient lower extremity ischemia that resolves following removal of the balloon catheters or their introducing sheaths.…”

“…11,16,17 Since the incidence of complications is unknown, some authors have called for a registry of complications to be formed. 3 In addition, it is not known if the degree of invasion of the placenta has any bearing on the efficacy of endovascular balloons. Taking into consideration the current lack of randomized control trials, we have shown that the risks of this procedure to the mother and to the fetus must be weighed carefully.…”

“…Balloon inflation or injection of embolizing material may then be used to decrease uterine blood flow, thereby facilitating control of postpartum hemorrhage. 3 Due to its novelty and the lack of randomized controlled trials, the indications, benefits, and risks of this technique remain unclear. To understand the risks associated with this technique, it remains necessary to provide descriptions of complications and their effect on outcomes.…”

Delayed bleeding after prophylactic bilateral internal iliac artery balloon occlusion in elective caesarean hysterectomy for the management of placenta accreta

“…8 The goal of internal iliac artery balloon occlusion is to temporarily occlude the internal iliac arteries in order to reduce uterine perfusion and decrease the rate of blood flow, thereby reducing blood loss, improving visualization during surgery, allowing for urgent arterial embolization (if require), and possibly preventing hysterectomy. 12 However, until now there is still a lack of significant evidence showing the benefit in terms of haemorrhage control and uterus preservation. Failed occlusion of the internal iliac arteries which is often due to extensive anastomosis in the pelvic vasculature and technique-related complications have been contributed to the controversy over this procedure.…”

Perioperative Internal Iliac Artery Balloon Occlusion in Patients with Abnormal Placental Invasion

“…Undoubtedly internal iliac artery balloon occlusion reduce blood supply to the pelvic organs and may prevent life threatening intraoperative blood loss, reduce transfusion requirements and improve visualization of the surgical field during cesarean hysterectomy [13]. However the substantial network of collateral vessels in the female pelvis, many times limit the efficacy of this technique [13][14][15][16][17].…”