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Prophylactic bilateral internal iliac artery balloon occlusion with immediate sheath removal for placenta accreta
Sooyeon Joy Kim1, Natalie Layden2, Scott Fleming2
1Medical Imaging and Interventional Radiology Department, Fiona Stanley and Fremantle Hospitals Group, South Metropolitan Health Service, Murdoch, WA, 6150, Australia. joy.kim@health.wa.gov.au.
Insights
Prophylactic internal iliac arterial balloon occlusion (PIIABO) is a safe endovascular procedure for managing placenta accreta spectrum (PAS). This study found PIIABO with immediate sheath removal had favorable outcomes and low complication rates in PAS patients.
Area of Science:
- Obstetrics and Gynecology
- Vascular Surgery
- Interventional Radiology
Background:
- The incidence of placenta accreta spectrum (PAS) is rising globally and in Australia.
- Prophylactic internal iliac arterial balloon occlusion (PIIABO) is an endovascular technique used to control hemorrhage during cesarean delivery for PAS.
- PIIABO offers a uterus-preserving alternative to hysterectomy, but outcomes are variable.
Purpose of the Study:
- To evaluate the endovascular safety of PIIABO with immediate sheath removal in PAS management.
- To assess the hemostatic and procedural outcomes of PIIABO in PAS patients.
Main Methods:
- A 10-year retrospective, single-center cohort study was conducted.
- Data were collected from electronic medical records and Radiology Information System (RIS)/Picture Archiving and Communication System (PACS).
- The study included all patients with suspected PAS who underwent PIIABO.
Main Results:
- Fifteen patients underwent PIIABO, with a mean maternal age of 34.1 years.
- Mean estimated blood loss was 2273 mL; 11 patients received blood transfusions.
- No endovascular complications or reinterventions occurred, and all mothers and neonates were discharged without long-term morbidity.
Conclusions:
- PIIABO with immediate sheath removal demonstrated favorable procedural outcomes.
- The study supports the safe implementation of PIIABO within a multidisciplinary care pathway for PAS.
- A low complication rate was observed in patients managed with PIIABO.
Background:
Consistent with global trends, the incidence of placenta accreta spectrum (PAS) is increasing in Australia. Prophylactic internal iliac arterial balloon occlusion (PIIABO) is an endovascular intervention utilised to assist haemorrhage control during caesarean delivery in women with PAS, offering a potentially uterus-preserving alternative to hysterectomy. However, existing outcomes remain heterogeneous. This study aimed to evaluate the endovascular safety of PIIABO with immediate sheath removal in the management of PAS, with a secondary assessment of haemostatic and procedural outcomes.
Materials And Methods:
A 10-year retrospective, single-centre cohort study of all patients with suspected PAS who underwent PIIABO was conducted with data obtained from electronic medical records and Radiology Information System (RIS)/Picture Archiving and Communication System (PACS).
Results:
Fifteen patients underwent PIIABO. The mean maternal age was 34.1 years, with a mean gravidity of 4.2 and a parity of 2.3; all had prior caesarean delivery and 93% had concurrent major placenta praevia (n = 14). Mean gestational age at delivery was 34.9 weeks. Diagnosis was established by MRI (n = 11, 87.5% concordance) and ultrasound (n = 4, 50% concordance). Twelve patients underwent hysterectomy, confirming 1 accreta, 3 increta, and 8 percreta; 3 patients preserved uterus, with intraoperative evidence of percreta (n = 2) or normal placentation (n = 1). Mean estimated blood loss was 2273 mL, and 11 patients received blood transfusions, including four who required ≥ 4 units of packed red blood cells. Mean balloon inflation time was 129.9 min, sheath dwell time 265.5 min, and operating theatre time 265.7 min. Mean dose-area product was 55.03 Gy.cm2 with a mean fluoroscopy time of 10.7 min. Radiation exposure decreased by approximately 90% over the study period with increasing institutional experience. No endovascular complications or reinterventions occurred, and all mothers and neonates were discharged without long-term morbidity.
Conclusion:
PIIABO with immediate sheath removal demonstrated favourable procedural outcomes and a low complication rate in patients with PAS, supporting its safe implementation within a multidisciplinary care pathway.
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