Bilateral Internal Iliac Artery Research Articles

Retrospective case-control study on radiation dose for uterine artery embolization procedures.

Uterine artery embolization is performed in pre-menopausal women. Understanding the contribution of radiation dose at each stage of the procedure is important for potential dose reduction. The aim was to retrospectively analyse radiation dose on a per-procedural-stage basis, comparing digital subtraction angiography (DSA) and conventional roadmap (CRM). Group A consisted of 50 patients where DSA was used for road mapping at all stages: (I) Aortogram, (II) Left internal iliac artery (IIA) DSA, (III) Left uterine artery (UA) DSA, (IV) Right IIA DSA and (V) Right UA DSA. Group B included 50 patients, where CRM was used for road mapping at stages (II) and (IV). For Group A, mean total dose-area product (DAP) was 39.7 Gy·cm2; mean DAP for each stage were (I) Aortogram = 3.4 Gy·cm2, (II) Left IIA DSA = 5.9 Gy·cm2, (III) Left UA DSA = 3.2 Gy·cm2, (IV) Right IIA DSA = 5.5 Gy·cm2 and (V) Right UA DSA = 3.0 Gy·cm2. For Group B, mean total DAP was 33.6 Gy·cm2, mean DAP for each stage were (I) Aortogram = 3.3 Gy·cm2, (II) Left IIA CRM = 1.5 Gy·cm2, (III) Left UA DSA = 3.3 Gy·cm2, (IV) Right IIA CRM = 1.5 Gy·cm2 and (V) Right UA DSA = 3.3 Gy·cm2. Fluoroscopy time was 10 and 9.4 min for Groups A and B, respectively. The highest road-mapping radiation dose contribution was from bilateral IIA DSA. The use of CRM, intermittent fluoroscopy and elimination of the aortogram is recommended to further reduce procedural radiation dose.

Bilateral Eggshell-like Internal Iliac Artery Aneurysms.

Bilateral Eggshell-like Internal Iliac Artery Aneurysms.

Surgical Strategies in Placenta Accreta Spectrum; A Quasi-experimental study

Objective: To evaluate maternal outcome in placenta accrete spectrum with bilateral internal iliac artery ligation before and after obstetric hysterectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital, Kharian Pakistan, from Oct 2022 to Sep 2023. Methodology: Seventy patients enrolled in the study underwent peripartum hysterectomy. Bilateral Internal Iliac Ligation was performed before obstetrical hysterectomy in 40 patients of Group -1, whereas it was done after hysterectomy in 37 patients of Group-2. In all cases, the baby was delivered via classical caesarean section, with the placenta left in situ, followed by the closure of the uterine incision. The number of blood transfusions, Intensive care unit stay, post-operative haemoglobin level, post- operative recovery events, and duration of hospital stay, along with demographic details, were noted. Results: Out of 77 patients, the mean age of patients was 28.79±3.05. Most patients (n=36, 46.8%) had the previous three scars. Fifty-four cases (70.1%) had bladder injury involving mucosa. 22(28.6%) females had post- operative haemoglobin ≤7g/dl. Our study revealed statistically significant differences in the type of bladder injury (p=0.024) and post- operative severe anaemia, i.e. Hb≤7g/dl (p=0.006) among the two groups. Conclusion: Bilateral internal iliac artery ligation prior to obstetrical hysterectomy leads to a reduction in post-operative severe anaemia and mucosal involvement in bladder injury.

Bilateral Internal Iliac Artery Ligation and its Role in Reducing Maternal Mortality

Background: Post-partum hemorrhage (PPH) is a common complication, seen following 2-4% vaginal deliveries and 6% of caesarean sections. 35% of maternal mortality worldwide (1) and 38% of maternal mortality in India can be attributed to PPH. Material and Methods: Women who had B/L IIAL over a period of 1year 2021 at Dr. VVP Pravara Rural Hospital, Loni were reviewed retrospectively. Patients were identified using hospital records and operation theatre registers. Clinical history, routine blood investigations, patient demographic data including age, parity, mode of delivery and surgical outcome with complications of procedure were noted. Results: A total of 30 PPH deliveries were conducted during the year 2021. most common indication for B/L IIAL was PPH, seen in 26 out of 30 cases (86.6%) followed by 3 cases of placenta accreta spectrum (1%) and 1 (0.3%) with gynecological complication. Of the 30 cases requiring B/L internal iliac ligation, 9 (30%) were primigravida, 3 (10%) second gravida and 18 (60%) multiparas with 2 or more prior deliveries. Of the 5 cases further requiring obstetric hysterectomy, 2 were second gravidas and 2 multiparas. Conclusion: The ligation of the internal iliac artery as a procedure to stop pelvic hemorrhage is not practiced as commonly as it should be. However, it is safe and effective method to control massive pelvic hemorrhage in experienced hands.

Emergency Bilateral Internal Iliac Artery Ligation in Antepartum Haemorrhage with Complete Placenta Previa and Placenta Accreta at Previous Caesarean Scar Site: A Case Report

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy.

Bilateral Renal Cortical Necrosis and Reversible Cerebral Vasoconstriction Syndrome in a Case of Severe Postpartum Haemorrhage

Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys’ cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient’s condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases.

Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation (BHGAL) due to severe postpartum hemorrhage

Objective: To evaluate the effect of bilateral hypogastric artery ligation (BHGAL) on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage. Methods: Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study. The records of cases were obtained from the hospital database, retrospectively. Maternal demographic data, morbidities or complications associated with BHGAL surgery, any additional haemostatic interventional or surgical procedures, preoperative admission and lowest postoperative haematocrit-hemoglobin values, blood products given, type of anaesthesia, intensive care unit (ICU) and length of hospital stay were recorded. In cases without surgical sterilization, future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation. Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed. Results: Sixty-eight patients with BHGAL surgery history were included in the study. 26 Of 37 cases (70%) that did not undergo surgical sterilization had a desire for pregnancy after the surgery. Six of these cases (23%) were diagnosed with secondary infertility. The fertility rate of these cases was 77%, and subsequent pregnancy was detected in 20 women. A total of 25 pregnancies, including first and second pregnancies, developed, and 15 of these pregnancies resulted in term delivery, six preterm births, one stillbirth, and three abortions. Conclusions: The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems, and this surgery does not seem to adversely affect pregnancy outcomes. This is a tertiary center experience and cohort studies with large patient series are needed.

Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms

This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.

Usefulness of knowledge in anatomy of the internal iliac artery in its ligation during life-threatening pelvic haemorrhages

Introduction: Post-Partum haemorrhage is a significant cause of maternal mortality. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynaecological haemorrhages. Bilateral internal iliac artery ligation results in toning down the pulsatility making the arterial flow a slow venous flow encouraging the clot formation of the damaged pelvic vessels. This study assesses the retroperitoneal anatomy and regional variations of the internal iliac artery.Methods: The study was based on examining 45 pelvic halves (23 right sides and 22 left sides), which were dissected during the gross anatomy laboratory at the faculty of medicine, Ragama, University of Kelaniya, from 2020 -2023. There were all adult pelvises. The internal iliac artery and its major branches were carefully dissected and examined. Adachi classification was used to classify the distribution pattern of the internal iliac artery. The study was done on the donated cadavers, and the nature of the study did not warrant any special ethical clearance. No conflict of interest.Results: No anatomical deviation has been noted with regard to the levels of division of aorta, common iliac artery, the division into internal and external iliac arteries and the division of anterior and posterior branches of the internal iliac artery from that of classical anatomical literature. It was also noted that there had been no significant deviation of anatomical relations with regard to the structures as described in the internal lilac artery in our study. In our study, Type Ia was found in 35/45 (78%) of the specimens, Type IIa in 3/45 (6%), Type III in 7 (16%), and no specimens were found with Type IV and. Type V.Conclusion: Our study showed no significant anomalies of the pelvic anatomical structural relations to the internal iliac artery. The type Ia branching pattern was found to be the commonest.

Intraoperative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement during Cesarean Hysterectomy for Placenta Accreta Spectrum

PurposeTo 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 MethodsAn 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. ResultsA 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. ConclusionsProphylactic 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.

Incidence and Outcomes of Visceral Ischemia in Acute Aortic Occlusion

Acute aortic occlusion (AAO) is a morbid diagnosis in which mortality correlates with severity of ischemia on presentation. Visceral ischemia (VI) is challenging to diagnose and its presentation as a consequence of AAO is not well-studied. We aim to identify characteristics associated with VI in AAO to facilitate diagnosis. Patients diagnosed with AAO who underwent revascularization were identified retrospectively from institutional records (2006-2020). The primary outcome was the development of VI (intra-abdominal ischemia). Univariate analysis was used to compare demographic, exam, imaging, and intraoperative variables between patients with and without VI in the setting of AAO. Ninety-one patients were included. The prevalence of VI was 20.9%. Preoperative comorbidities, time to revascularization, and operative approach did not differ between patients with and without VI. Patients with VI more frequently were transferred from outside institutions (100% vs. 53%, P=0.02), presented with advanced acute limb ischemia (Rutherford III 36.9% vs. 7.5%, P<0.01), and had elevated preoperative serum lactate (4.31 vs. 2.41mmol/L, P<0.01). VI patients had an increased occurrence of bilateral internal iliac artery (IIA) occlusion (47.4% vs. 18.1%, P=0.01). Unilateral IIA occlusion, level of aortic occlusion, and patency of inferior mesenteric arteries were not associated with VI. Patients with VI had worse postoperative outcomes. In particular, VI conferred significant risk of mortality (odds ratio 5.45, P<0.01). Visceral ischemia is a common consequence of AAO. Elevated lactate, bilateral IIA occlusion, and advanced acute limb ischemia (ALI) should increase clinical suspicion for concomitant VI with AAO and may facilitate earlier diagnosis to improve outcomes.

Clinical Outcomes of Internal Iliac Artery Interruption during Endovascular Aneurysm Repair.

This study aimed to investigate the clinical outcomes of internal iliac artery (IIA) interruption during endovascular aneurysm repair (EVAR) and to identify the risk factors for ischemic complications. Endovascular treatment was performed in 316 patients with aneurysms or pseudoaneurysms of the abdominal aorta or iliac arteries between March 2006 and January 2022. Medical records and radiological imaging studies were retrospectively reviewed. The incidences of buttock claudication, ischemic colitis, and spinal cord ischemia after IIA interruption were investigated as clinical outcomes. Binary logistic regression analysis were performed to identify the risk factors. IIA embolization was performed in 78 patients. Among the 42 patients who underwent IIA flow preservation procedures, the one-month computed tomography detected early failure in five patients. The origin of the IIA was covered with an endograft in ten patients who did not undergo embolization. Eventually, interruption of the IIA by EVAR was observed in 93 patients. Considering preoperative IIA occlusion, there was a total of six patients who did not have at least one IIA patency. Buttock claudication occurred in 32.6% of the patients, and none of the patients had ischemic colitis or spinal cord ischemia. In multivariable analysis, age ≤80 years and isolated iliac artery aneurysm were associated with the development of postoperative buttock claudication. The most common complication after IIA interruption is buttock claudication; however, critical complications such as ischemic colitis or spinal cord ischemia are rare, even in bilateral IIA occlusion. Adjunctive procedures to preserve bilateral IIA perfusion should be adopted selectively.

Endovascular revascularization of isolated internal iliac artery for symptomatic occlusive atherosclerotic disease is a viable and underused option for patients with gluteal muscle claudication

Often confused with pseudoclaudication, gluteal muscle claudication is a difficult condition to diagnose and treat. We present the case of a 67-year-old man with a history of back and buttock claudication. He had undergone lumbosacral decompression with no relief of buttock claudication. Computed tomography angiography of the abdomen and pelvis showed occlusion of the bilateral internal iliac arteries. Exercise transcutaneous oxygen pressure measurements obtained on referral to our institution revealed a significant decrease. He underwent successful recanalization and stenting of the bilateral hypogastric arteries with complete resolution of his symptoms. We also reviewed the reported data to highlight the trend in the management of patients with this condition.

Analysis of Repair Type and Hypogastric Artery Antegrade Perfusion and Erectile Function following Repair of Abdominal Aortic Aneurysms

Published reports suggest that exclusion of antegrade hypogastric artery flow may have deleterious effects on erectile function after abdominal aortic aneurysm (AAA) repair. Off-label and open surgical hybrid procedures and, more recently, purpose-built branched devices have been developed to maintain antegrade pelvic perfusion in patients undergoing endovascular repair. Maintaining antegrade perfusion may reduce a spectrum of risks, including buttock claudication, colorectal ischemia, and spinal cord ischemia when patients undergo subsequent thoracic aortic procedures, as well as erectile dysfunction (ED). This project specifically focuses on erectile function, and analyzes baseline associations and relationships of hypogastric artery exclusion on changes in erectile function following aneurysm repair. Male patients in the Veterans Affairs Open Versus Endovascular Repair (CSP#498; OVER) Trial had erectile function assessed preoperatively and postoperatively by administration of the International Index of Erectile Function-5 questionnaire. Bayesian mixed-effects regression models were created with the outcome variable (erectile function) treated as a latent variable. Primary effects of differences in erectile function between groups with and without preservation of bilateral antegrade hypogastric flow were compared. 876 men (442 randomized to endovascular repair) were enrolled in the trial and included in the analysis comparing treatment assignment. There is significant ED in elderly men with aortic aneurysm at baseline. Over 5years of follow-up, there is modest decrease in erectile function and the endovascular group has improved function compared to open repair (0.082; 95% credible interval (CI) 0.008 and 0.155). A fifth of patients did not have bilateral preservation of antegrade hypogastric artery perfusion, with no difference in erectile function by univariate analysis. A more detailed regression analysis was applied--and after adjustment for baseline score, age, beta blocker use, diabetes, activity level, ejection fraction, preoperative ankle-brachial indices and time--preservation of both antegrade hypogastric arteries' perfusion showed transient improvement in survey scores compared to occlusion of at least 1 hypogastric artery at 6months and 12months after treatment, although this was not sustained at 60months (score change: 0.046; 95% CI: -0.123, 0.215). Retesting this model in the cohort with complete data as a sensitivity analysis did not meaningfully change the conclusions. In this large prospective aneurysm treatment trial with systematic measurement of erectile function with a validated instrument, endovascular repair is associated with improved erectile function. Preservation of antegrade hypogastric flow with any repair is associated with early improved erectile function; however, it is not a sustained benefit. There is limited benefit of maintaining bilateral hypogastric artery perfusion for this specific indication in unselected men undergoing AAA repair.

Prophylactic bilateral internal iliac balloon occlusion to control hemorrhage in placenta accreta spectrum: a boon for obstetricians.

Placenta accreta spectrum (PAS) is abnormal placental adhesion beyond superficial myometrium, which may lead to severe life-threatening hemorrhage requiring massive blood transfusions in the peripartum period. Prophylactic balloon catheterization of bilateral internal iliac arteries with or without additional embolization with Cesarean hysterectomy in patients with PAS prevent excessive intraoperative hemorrhage and may also obviate the need for hysterectomy. To study the efficacy of intervention radiological procedures in controlling intraoperative hemorrhage in patients with PAS. This ethically approved prospective study was conducted between November 2017 and October 2019 and written informed consent was obtained from all patients. Consecutive patients diagnosed with PAS during the antepartum period were evaluated. A total of 18 patients with PAS underwent prophylactic balloon catheterization of the bilateral internal iliac arteries followed by delivery of the infant. Interventional and intraoperative data of these patients were collected and compared with retrospectively collected data of patients (control group) who underwent hysterectomy without prophylactic balloon occlusion over the past four years (January 2016-November 2019). Significantly lower intraoperative blood loss (2.8 L vs. 4.7 L; P = 0.048) and pure red blood cell (PRBC) requirement (P = 0.026) between patients who had hysterectomy with and without interventional radiological management was observed. Significantly higher blood loss (P = 0.006) and fluid requirement (P = 0.007) was observed with a higher degree of placental invasion. Only 1 (6%) major procedure-related complication was observed. Interventional radiological procedures are effective in significantly reducing intraoperative blood loss and blood product requirement in patients with PAS.

Covered Endovascular Reconstruction of Ιnternal Ιliac Bifurcation (CERIΙB)

Purpose: The aim is to present a case of bilateral internal iliac artery aneurysms (IIAAs) endovascular repair without proper distal landing zone using an off the shelf technique of Covered Endovascular Reconstruction of Internal Iliac Bifurcation (CERIIB). Technique: A 67- year-old male had a known history of open surgical repair of an infrarenal AAA 12 years ago. During follow up, computed tomography angiography (CTA) revealed bilateral internal iliac artery aneurysms (30 mm of diameter). We used a technique deploying firstly a balloon expandable covered stent (BXCS) in the proximal part of the IIA, and then two parallel BXCS in the two main outflow branches of each IIA. In the left side additional a kissing stent technique was undertaken (BXCS in external and a balloon into the IIA). The postoperative course of the patient was uneventful and was he discharged at second post-operative day, while the first-month CTA demonstrated optimal outcome.

Comparative analysis of second- and third-trimester complete uterine rupture cases followed up in a tertiary hospital: a retrospective cohort study

Aim: There are not many studies that compared the uterine rupture cases pertaining to different trimesters of pregnancy in terms of the changes in relevant risk factors and fetomaternal outcomes. In this context, this study was carried out to comparatively analyze the cases who were diagnosed with complete uterine rupture and gave birth in the hospital where this study was conducted in terms of the relevant risk factors and fetomaternal outcomes.&#x0D; Material and Method: The population of this retrospective study consisted of patients who were diagnosed with complete uterine rupture and gave birth in our hospital between January 2015 and June 2022. Patients’ demographic characteristics, cesarean section, labor induction histories, and fetal and maternal outcomes were recorded. The patients included in this study were divided into two groups based on the trimester when the complete uterine rupture occurred as second- and third-trimester complete uterine rupture groups. The groups were compared in terms of fetal, maternal, and obstetric outcomes.&#x0D; Results: Out of the 56718 deliveries performed during the study period, a total of 27 complete uterine rupture cases, of whom 10 had second-, and 17 had third-trimester uterine rupture, were included in the study sample. Accordingly, the incidence of rupture was calculated as 0.047%. Of these 27 cases, 9 had re-pregnancy. Bilateral hypogastric artery ligation was performed in seven patients and six of these patients were in the third trimester rupture group. Of the 27 cases with complete uterine rupture, 19 had a cesarean section history. All 8 cases that did not have a cesarean section history had a complete uterine rupture in the third trimester.&#x0D; Conclusion: Complete uterine rupture is associated with adverse maternal and fetal outcomes. Fertility-sparing surgery (primary repair) is the first-line therapy. The prognosis of second-trimester uterine ruptures is more unfavorable compared to third-trimester uterine ruptures from the fetal point of view yet more favorable from the maternal point of view.

Analysis of the Risk Factors for Massive Hemorrhage in Pernicious Placenta Previa and Evaluation of the Efficacy of Internal Iliac Artery Balloon Occlusion.

To investigate the risk factors of intraoperative massive hemorrhage in patients with pernicious placenta previa (PPP) and analyze the value of bilateral internal iliac artery balloon occlusion in Cesarean section for these patients. The clinical data of 134 patients with PPP admitted to the Second Hospital of Shanxi Medical University from January 2012 to January 2019 were analyzed. A logistic regression analysis was used to analyze the risk factors for intraoperative massive hemorrhage in PPP. The study subjects were divided into the intervention group (38 cases) and the routine group (96 cases) according to whether bilateral internal iliac artery balloon occlusion was conducted during the operation. The differences in some clinical indicators were compared between the two groups. The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. The differences in the operation time, postoperative transfer to the intensive care unit, postoperative length of the hospital stay, and neonatal weight and score were not statistically significant between the intervention group and the routine group (P > 0.05 for all). While the intraoperative blood loss and the transfusion volume in the intervention group were lower than in the routine group, the hospitalization cost was higher in the former than in the latter, and the differences were statistically significant (P < 0.05 for all). Moreover, there was no case of hysterectomy in the intervention group, while there were two cases of hysterectomies in the routine group. The risk factors for intraoperative massive hemorrhage in PPP were age ≥35 years, gestational age ≥34 weeks, complete placenta previa, and the presence of placenta accreta. Internal iliac artery balloon occlusion during PPP could reduce intraoperative blood loss and the hysterectomy rate.

Effectiveness and safety of bilateral internal iliac artery ligation with pre-peritoneal pelvic packing for life-threatening pelvic trauma

This study analyzed the outcomes of bilateral internal iliac artery (IIA) ligation with preperitoneal pelvic packing (PPP) in hemodynamically unstable patients with major pelvic fractures. All-cause mortality was examined, periprocedural safety for critical circumstances was reviewed, and iliac artery ligation-related complications of the postoperative phase were evaluated. A total of 20 patients who suffered substantially from severe pelvic trauma with hemodynamic instability and subsequently underwent bilateral IIA ligation with PPP between January 1, 2017, and December 31, 2021, were enrolled in the study. The median participant age was 60.5 years, and 65.0% were male. The median systolic blood pressure was 68.5 mmHg on arrival. Increased lactate level (median, 11.05 mmol/L) suggested that the patients were in shock distinctly due to hypovolemia. It took approximately 1 h to complete the ligation of bilateral IIA to accomplish hemostasis (median, 65.5 min). The iliac vein was injured during dissection in three cases. During the ICU stay (median, 17.5 days), acute kidney injury was identified in 13 patients, likely due to volume depletion. The median ventilator-free days was 13.5; six patients were confirmed with ventilator-associated pneumonia. Moreover, 12 patients were diagnosed with acute respiratory distress syndrome. There was one case in which the lower extremity artery was acutely occluded. Anatomic hemostasis was achieved in 18 patients. The two patients for which anatomic hemostasis failed became two mortality cases from preperitoneal hemorrhage. Our analysis showed that bilateral IIA ligation with PPP was effective as a lifesaving procedure in hemodynamically unstable patients with a major pelvic fracture in terms of mortality due to fracture-related exsanguination. Moreover, the incidence of periprocedural complications was considered tolerable, making the procedure worth a try, especially in austere and underdeveloped healthcare settings.

Hypogastric Artery Salvage Associated with Decreased Postoperative Cardiac and Renal Complications

Hypogastric Artery Salvage Associated with Decreased Postoperative Cardiac and Renal Complications