Vascular control by infrarenal aortic cross‐clamping in placenta accreta spectrum disorders: description of technique

Abstract

We describe a novel surgical technique in 31 women with histopathologically confirmed placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team using a prophylactic infrarenal abdominal aortic cross‐clamping technique during caesarean hysterectomy. We conclude that this new surgical procedure is a relatively safe technique to potentially control operative blood loss. Our work may stimulate others to develop protocols assessing this innovative technique to improve the surgical outcome of PAS disorders.

Authors’ reply re: Vascular Control by Infrarenal Aortic Cross-Clamping in Placenta Accreta Spectrum Disorders: description of technique. (Response to BJOG-20-2523)

“…We thank Nieto-Calvache et al for their insightful comments (1) on our article (2). We agree with their point that the choice of vascular control techniques should be determined by the topography and severity of PAS disorders.…”

“…Even with ACC, the surgeries were still challenging, especially in dissecting the bladder wall away from the extremely hypervascular lower uterine segment. The surgical procedures were prolonged and extensively neovascularization couldn't be completely occluded due to the three anastomotic pathways outside the vascular control provided by ACC (2).…”

Authors' reply re: Vascular control by infrarenal aortic cross‐clamping in placenta accreta spectrum disorders: description of technique

“…We thank Nieto‐Calvache et al for their insightful comments 1 on our article 2 . We agree with their point that the choice of vascular control techniques should be determined by the topography and severity of placenta accreta spectrum (PAS) disorders.…”

“…Even with ACC, the surgeries were still challenging, especially dissection of the bladder wall away from the extremely hypervascular lower uterine segment. The surgical procedures were prolonged and extensiv neovascularisation could not be completely occluded due to the three anastomotic pathways outside the vascular control provided by ACC 2 …”

Re: Vascular control by infrarenal aortic cross‐clamping in placenta accreta spectrum disorders: description of technique

“…We read with interest the paper by Chou et al 1 describing 31 patients with placenta accreta spectrum (PAS) in which aortic cross‐clamping (ACC) was used prophylactically. I congratulate the authors for highlighting the usefulness of aortic occlusion (AO) as a strategy to prevent massive bleeding during PAS surgeries, a beneficial topic in low‐ and middle‐income countries where endovascular devices are not available in many hospitals.…”