Prophylactic occlusion balloon in placenta abnormalities: What every interventional radiologist needs to know

Abstract

Placenta abnormalities, which are collectively termed as placenta accreta spectrum (PAS), are increasing globally in the female population due to the large number of cesarean sections performed worldwide. PAS represents a rare but life-threatening occurrence that can lead to an increased risk of postpartum hemorrhage due to the abnormal infiltration of the chorionic villi in the uterine wall up to the adjacent structures. Performing a prophylactic occlusion of the iliac arteries for a brief amount of time using balloon-occlusion endovascular catheters in patients with PAS can help control unwanted blood losses during cesarean delivery or postpartum demolition surgery. The aim of this narrative minireview was to provide an overview of the aspects about prophylactic occlusion with endovascular balloons in patients with PAS and to analyze current evidence on this topic. In particular, this minireview included an overview of indications, patient selection, type of materials and devices used, technical advice and suggestions, clinical outcomes, and complications to give every interventional radiologist as well as every gynecologist and midwife all the information that is needed to address this particular condition in a safe and prompt manner.

Keywords: Balloon occlusion; Endovascular; Interventional radiology; Placenta accreta; Postpartum hemorrhage.

Figure 1

Digital subtraction angiography. Balloon positioning between the right internal iliac artery and the common iliac artery in a 24-years-old pregnant female.