학술논문
Intraoperative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement during Cesarean Hysterectomy for Placenta Accreta Spectrum.
Document Type
Academic Journal
Author
Berman ZT; Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California. Electronic address: ZBerman@health.ucsd.edu.; Boone CE; Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California.; Melber DJ; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California.; Ballas J; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California.; Parikh R; Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California.; Ramos G; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California.; Kelly T; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California.; McHale M; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, California.; Picel AC; Department of Radiology, Division of Interventional Radiology, Stanford University, Stanford, California.; Roberts AC; Department of Radiology, Division of Vascular and Interventional Radiology, University of California San Diego, San Diego, California.
Source
Publisher: Society of Cardiovascular and Interventional Radiology Country of Publication: United States NLM ID: 9203369 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-7732 (Electronic) Linking ISSN: 10510443 NLM ISO Abbreviation: J Vasc Interv Radiol Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: To evaluate the effectiveness and safety of prophylactic multivessel selective embolization (MVSE) compared to those of internal iliac artery occlusion balloon (IIABO) placement in patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS).
Materials and Methods: An institutional review board-approved retrospective series was conducted with consecutive patients with PAS at a single institution between 2010 and 2021. MVSE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries, which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring transfusion, and adverse events were recorded.
Results: A total of 20 patients treated with embolization and 34 patients with balloon placement were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss in the MVSE group was 713 mL (interquartile range [IQR], 475-1,000 mL) compared to 2,000 mL (IQR, 1,500-2,425 mL) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and percentage of cases requiring a transfusion (20% vs 65%) were less in the MVSE group (P < .01). A median of 4 vessels (IQR, 3-9) were embolized during MVSE. No major adverse events or nontarget embolization consequences were observed.
Conclusions: Prophylactic MVSE is a safe procedure that reduces operative blood loss and transfusion requirements compared to those of IIABO in patients undergoing cesarean hysterectomy for presumed higher-degree PAS.
(Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)
Materials and Methods: An institutional review board-approved retrospective series was conducted with consecutive patients with PAS at a single institution between 2010 and 2021. MVSE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries, which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring transfusion, and adverse events were recorded.
Results: A total of 20 patients treated with embolization and 34 patients with balloon placement were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss in the MVSE group was 713 mL (interquartile range [IQR], 475-1,000 mL) compared to 2,000 mL (IQR, 1,500-2,425 mL) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and percentage of cases requiring a transfusion (20% vs 65%) were less in the MVSE group (P < .01). A median of 4 vessels (IQR, 3-9) were embolized during MVSE. No major adverse events or nontarget embolization consequences were observed.
Conclusions: Prophylactic MVSE is a safe procedure that reduces operative blood loss and transfusion requirements compared to those of IIABO in patients undergoing cesarean hysterectomy for presumed higher-degree PAS.
(Copyright © 2023 SIR. Published by Elsevier Inc. All rights reserved.)