The benefit of additional embolization after perioperative balloon occlusion of pelvic artery during cesarean hysterectomy in placenta accreta spectrum
Issued Date
2025-01-01
Resource Type
ISSN
02841851
eISSN
16000455
Scopus ID
2-s2.0-85216217254
Journal Title
Acta Radiologica
Rights Holder(s)
SCOPUS
Bibliographic Citation
Acta Radiologica (2025)
Suggested Citation
Feinggumloon S., Hansahiranwadee W., Panpikoon T., Buangam C., Pichitpichatkul K., Chansanti O., Treesit T. The benefit of additional embolization after perioperative balloon occlusion of pelvic artery during cesarean hysterectomy in placenta accreta spectrum. Acta Radiologica (2025). doi:10.1177/02841851241312222 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/104186
Title
The benefit of additional embolization after perioperative balloon occlusion of pelvic artery during cesarean hysterectomy in placenta accreta spectrum
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Cesarean hysterectomy in the placenta accreta spectrum (PAS) remains challenging due to difficulty in controlling perioperative bleeding. Purpose: To compare the effectiveness and safety of perioperative balloon occlusion with versus without pelvic artery embolization in PAS women who underwent a cesarean hysterectomy. Material and Methods: A total of 26 pathological confirmed cases of PAS were retrospectively reviewed and categorized into two groups: perioperative balloon occlusion at either the anterior division of the internal iliac artery or uterine artery followed by gelfoam embolization (n = 12, study group) and perioperative balloon occlusion alone (n = 14, control group). Intraoperative estimated blood loss (EBL), a unit of packed red blood cell (pRBC) transfusion, surgical time, transfer to the intensive care unit (ICU), postoperative hospitalization days, postoperative complications, and Apgar scores were compared between the two groups. Results: The median and interquartile range (IQR) intraoperative EBL in the study group (1200 mL [700–2100 mLl]) was significantly lower compared to those in the control group (1900 mL [1300–3200 mL]) (P = 0.044). There was no significant difference between the study and control groups in units of pRBC blood transfusion, surgical time, transfer to the ICU, postoperative length of stay, postoperative complications, and mean Apgar score at 1 min and 5 min. Conclusion: The perioperative combination of balloon occlusion followed by embolization of the pelvic artery before cesarean hysterectomy is more effective in reducing blood loss than perioperative balloon occlusion alone in PAS with no difference in postoperative complications or neonatal outcomes.