4:42 PM; Abstract No. 144 - Internal iliac artery balloon occlusion placement for management of placenta accreta: a retrospective study

Abstract

Inflation of occlusion balloons in the internal iliac arteries can be performed in women with abnormal placental implantation at high risk of hemorrhage during surgery in the hopes of decreasing morbidity and mortality. However, due to the limited literature, this remains a controversial technique. The primary objective of our study is to review the outcomes of such cases at our institution. A search was performed to retrospectively identify all patients with abnormal placental implantation and pre-operative balloons placed between January 1st 2006 and June 30th 2013 at our institution. Data extracted included demographics, hemoglobin levels, blood transfusions, pathology and need for hysterectomy. 17 patients fulfilled the criteria, representing one of the largest samples ever published of this type of study. The indication for pre-operative balloon placement was placenta accreta in 11 patients, placenta increta in 1 patient and placenta percreta in 5 patients. Intra-operative balloon inflation was performed in 11 (65%) patients: 6 (65%) with placenta accreta, 1 (100%) with placenta increta (100%), and 4 (80%) with placenta percreta. The estimated operative blood loss for patients in whom the balloons were inflated was 750-4000mL (average 1450mL) versus 800-3000mL (average 1825mL) in patients in whom the balloons were not inflated (p=0.65). The average drop in hemoglobin between the group with and without inflation of balloon was 22Hgb/L and 31Hgb/L, respectively (p=0.21). Despite a trend toward decrease blood loss in patients with balloon inflation our data fails to demonstrated a statistically significant difference. While the data may seem to indicate the lack of usefulness of this technique, since the balloons are only inflated during surgery if bleeding is deemed excessive, both groups are not easily comparable. Assuming the surgeon’s impression of increased bleeding was correct, then balloon inflation may have been the only reason that this group of patients did not lose on average more blood than the other group. Carefully designed prospective studies will likely be needed to prove the usefulness of this technique.