Abstract
Surgical management of Placenta Accreta Spectrum (PAS) is, if anything, wrought with complexity. Placental invasion can be confined and relatively easy to manage or as surgically challenging as a Stage IV ovarian tumor. In the most extensive cases, the placenta is equally capable of encasing not only the ureter, but also the femoral vessels and obturator nerve, but instead of solid tumor, the surgeon is faced with a mixed solid-cystic structure that behaves like a large arteriovenous fistula until the blood supply from the uterine arteries and collaterals from the bladder are controlled.
Highlights
Surgical management of placenta accreta spectrum (PAS) is, if anything, wrought with complexity
We PAS surgical veterans will, always welcome effective tools and techniques targeted against massive haemorrhage
A rent in the adjacent thin-walled inferior vena cava (IVC) is more difficult to repair than the muscular aorta
Summary
Surgical management of placenta accreta spectrum (PAS) is, if anything, wrought with complexity. Even the well-intended, experienced vascular surgeon who has never encountered PAS risks inadvertently inciting haemorrhage, should he or she attempt to move the placenta to gain better exposure of the underlying vascular structures.
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