The role of internal iliac artery intraoperative vascular clamp temporary occlusion in abnormally invasive placenta

Abstract

Objective To investigate the efficacy of internal iliac artery intraoperative vascular clamp temporary occlusion in the treatment of abnormally invasive placenta. Method This retrospective study enrolled 153 patients diagnosed with abnormally invasive placenta between January 2018 and December 2021. The patients were divided into a study group (n = 88, undergoing cesarean section followed by internal iliac artery vascular clamp temporary occlusion) and a control group (n = 65, receiving routine cesarean section). The general situation, intraoperative conditions, postoperative complications, and neonatal outcomes were compared between the two groups. Results The hysterectomy rate in the study group was significantly lower than that in the control group. However, there were no significant differences in intraoperative blood loss, blood transfusion, postoperative intensive care unit transfer rate, or neonatal outcome between the groups. Further subgrouping showed that in patients with placenta increta, the hysterectomy rate and intraoperative bleeding amount were significantly lower in the occlusion group. Nevertheless, these advantages were not significantly different between the groups in patients with placenta percreta. Conclusion Vascular clamp temporary occlusion of internal iliac artery is an effective method for controlling hemorrhage and decreasing the incidence of hysterectomy in patients with placenta increta. For patients with placenta percreta, the benefit is limited.

Intraoperative temporary internal iliac arterial occlusion (Polat's technique) for severe placenta accreta spectrum: A description of the technique and outcomes in 61 patients

“…Temporary occlusion of IIA by Bulldog clamps was first reported by our group in 2017 11 . Then in 2023 the role of temporary occlusion on IIA by vascular clamps was investigated by Yang et al 8 in 153 patients with AIP—102 placenta increta and 51 placenta percreta 8 . They performed IIA occlusion after cesarean section in their study group of 88 patients, of whom 31 (38.7%) had placenta percreta and 9 (10.2%) had hysterectomy.…”

“…Multiple techniques are used to decrease intraoperative bleeding. Intraoperative temporary occlusion of internal iliac arteries (IIA) by vascular clamps in AIP has been reported to be effective for controlling hemorrhage and decreasing hysterectomy rates in patients with placenta increta, but limited benefit was shown for placenta percreta 8 . Prophylactic placement of intravascular balloon catheters showed no benefit in terms of blood loss in patients with placenta accreta scheduled for cesarean hysterectomy 9 .…”

“…Intraoperative temporary occlusion of internal iliac arteries (IIA) by vascular clamps in AIP has been reported to be effective for controlling hemorrhage and decreasing hysterectomy rates in patients with placenta increta, but limited benefit was shown for placenta percreta. 8 Prophylactic placement of intravascular balloon catheters showed no benefit in terms of blood loss in patients with placenta accreta scheduled for cesarean hysterectomy. 9 Permanent occlusion of IIA causes ischemic complications in 22.6% of cases, including buttock claudication in 12.2%, buttock necrosis in 4.8%, spinal cord ischemia in 4.0%, colonic ischemia in 2.5%, and bladder necrosis in 0.8%.…”

Roadmap to safety: a single center study of evidence-informed approach to placenta accreta spectrum

“…The Placenta Accreta (PACCRETA) study reported lower rates of blood transfusion but higher rates of arterial embolus, readmission and infection in those managed conservatively ( 23 ). Uterine-sparing surgical techniques, however, including temporary occlusion of the internal iliac arteries have been presented with promising outcomes ( 24 , 25 ). Patients referred to our program who, after imaging and team discussion, were eligible for a uterine sparing approach (i.e., preoperative imaging was not sufficiently suspicious for PAS) and underwent vaginal or cesarean delivery were not included in analysis.…”

The Evolution of Management Strategies for Placenta Accreta Spectrum

“…As with other obstetric complications, the management of PAS could be improved by applying high-quality prenatal assessments by ultrasound or magnetic resonance imaging; the application of this strategy could identify high-risk pregnancies. Expert opinions from China recommended scoring systems that integrate maternal risk factors with ultrasound features to further stratify the severity of PAS 9 . In 2019, the International Society for Placenta Accreta Spectrum (IS-PAS) delivered its own “evidence-based guidelines.” Together with Peking University First Hospital, the IS-PAS organized the 2020 Online International Workshop on PAS; the published minutes arising from this meeting emphasized the need for consistency for each classification of PAS.…”