Occlusion Of Common Iliac Artery Research Articles

A Man with Sudden Onset Leg Pain and Weakness.

An 89-year-old male who had been holding dabigatran in the setting of transcarotid artery revascularization presented to the emergency department with sudden onset leg pain and weakness. Computed tomography angiography revealed acute aortic occlusion and thrombosis of the bilateral common iliac arteries. He underwent aortoiliac and femoral embolectomies and stenting of the bilateral common iliac arteries and returned to his baseline functional status. Acute aortic occlusion is a rare but often devastating vascular emergency characterized by obstruction of the aorta by an embolus or thrombosis. Diagnosis can be challenging as it may be mistaken for spinal pathology, which can lead to delays in diagnosis. Despite advances in diagnostic modalities and interventions, acute aortic occlusion often results in high rates of major morbidity and mortality.

Acute Infrarenal Abdominal Aortic and Bilateral Common Iliac Artery Occlusions in an Elderly Female: A Case Report

Acute Infrarenal Abdominal Aortic and Bilateral Common Iliac Artery Occlusions in an Elderly Female: A Case Report

Endovascular abdominal aortic repair in a patient with common iliac artery occlusion

Endovascular abdominal aortic repair in a patient with common iliac artery occlusion

Bilateral Iliac Arteries Stent Compression Following Pelvic Surgery: A Case Report and Review of Literature

Extrinsic compression of iliac arteries stents has been reported from different causes, such as uterine fibroids and orthopedic surgery. Although extrinsic compression of stents in the iliac veins has been widely studied, stent compression in the iliac arteries is less common. Here we presented a case with bilateral common iliac arteries stent compression following pelvic surgery. A patient (65-year-old woman) presented with acute critical right limb ischemia. Computed tomography angiography (CTA) showed occlusion of the right common and external iliac artery, and severe stenosis in the left common iliac artery. In addition, there was evidence of a Brenner tumor originating from the left ovary. The patient underwent endovascular recanalization of the right iliac arteries and bilateral balloon-expandable stent deployment, and the ovarian tumor was removed after three weeks. The control CTA scan showed asymmetric bilateral iliac arteries stent compression more prominent on the right side, then self-expanding stents were implanted bilaterally. In Conclusion although iatrogenic compression of the stent in the iliac artery is rare despite scarcity, it is important to maintain a high index of suspicion in selected cases and choose the proper stent accordingly.

Abstract 16128: The Winslow Pathway and Internal Mammary Artery Harvesting in Patients With Aortoiliac Occlusive Disease

Introduction We present a case where the left Internal Mammary Artery (IMA) was not a straightforward choice as the grafted vessel in a patient undergoing Coronary Artery Bypass Grafting (CABG). Case Presentation Patient was a 66 years old female with Hypertension, Hyperlipidemia, hypothyroidism, and tobacco use disorder. Evaluation for a motor vehicle accident secondary to a syncopal episode, and intermittent chest tightness over the past few months, showed ST depressions on ambulatory electrocardiographic monitoring, reversible ischemia in the anterior and apical walls on Exercise Stress Test and severe multivessel coronary artery disease involving the distal main left coronary artery and its branches on Coronary Angiography. CABG was advised. Preoperative peripheral angiogram showed bilateral common iliac artery occlusion, precluding IABP placement. Selective angiography of the left IMA showed the left IMA to be the major vessel supplying collateral circulation to the left iliac system. Patient subsequently underwent CABG with bilateral Saphenous Vein Harvest. Discussion IMA harvesting in patients with Aortoiliac Occlusive Disease (AOD) with prominent collaterals through the subclavian-IMA-inferior epigastric-external iliac pathway, AKA the Winslow Pathway (WP), can result in limb threatening ischemia, and elective IMA angiography and/or doppler flow evaluation before CABG can help identify this important collateral pathway. Alternative approaches in patients with AOD include simultaneous coronary and peripheral revascularization, completely avoiding IMA harvesting or in some cases, angioplasty, although there is no consensus thus far.

Collateral Circulation − “Hand of God:” Salvaging the Transplant Kidney!

The physiological adaptation capability of any living being is necessary for survival. Vascular collaterals are proven to be maintaining organ perfusion in various situations such as ischemic heart disease, cerebrovascular disease, and peripheral vascular diseases. We are presenting here a postrenal transplant case with renal graft perfused by collaterals because of the complete occlusion of right common iliac artery. This was diagnosed while the patient presenting with right lower limb claudication pain. He required femoro-femoral graft to perfuse the right lower limb. The importance of pretransplant iliac vessels imaging and Doppler studies is emphasized.

Combining transradial access and sheathless femoral access for complex iliac artery chronic total occlusions

BackgroundThe transradial approach (TRA) is associated with fewer serious access site-related complications compared with the transfemoral or transbrachial approach. However, TRA has associated problems in complex aortoiliac (AI) lesions, including the procedural difficulty. A bidirectional approach was used combining TRA with a sheathless technique for femoral artery (FA) puncture to treat complex AI lesions, as a minimally-invasive approach. This report describes a representative cases with AI chronic total occlusion in which the combination of TRA and a sheathless technique for FA puncture was useful for guidewire crossing.Case presentationCase 1 was a 71-year-old man with intermittent claudication (IC). Control angiography showed total occlusion of the left common iliac artery (CIA) ostium to the distal external iliac artery (EIA). Guidewire externalization was achieved by combining TRA using a 6Fr guiding sheath and a sheathless technique for the left FA. Two nitinol stents were deployed in the CIA to EIA. Case 2 was a 63-year-old man with IC. Control angiography revealed total occlusion of the right CIA ostium to the common femoral artery (CFA) with severe calcification. The antegrade wire could not pass through the CTO lesion because of the calcified CFA occlusion. A 21-G metal needle was used to penetrate the CFA calcification through the distal true lumen of the CFA, and the wire was inserted into the EIA for wire externalization. Three nitinol stents were deployed in the CIA to EIA, and a drug-coated balloon was dilated in the CFA with hemostasis of the distal puncture site. In both cases, the retrograde puncture site was hemostatic during the procedure and postoperative bed rest was not required.ConclusionsTRA combined with a sheathless technique from the FA has the potential to treat AI complex lesions in a less invasive manner.

Persistent Sciatic Artery: A Case Report

Persistent sciatic artery (PSA) is a very rare congenital vascular anomaly, occurs in 0.025% to 0.04% of the population, and occasionally associated with thromboembolic events or aneurismal diseases. We herein share experience of diagnosis and successful treatment of a Vietnamese patient with PSA complicated with distal thromboembolism. A 70-year-old woman was admitted to the hospital for acute lower limb ischemia. A computed tomography angiography (CTA) revealed complete occlusion of the left common iliac artery. Surgical embolectomy was carried out and abnormal distal left femoral artery was noted intraoperatively. Postoperative CTA showed a persistent sciatic artery (PSA) on the left and adequate perfusion of the left lower limb. During 2 years follow-up, the patient remained symptom-free with good perfusion to the distal left popliteal artery, anterior and posterior tibial arteries.

Oxidative Stress and Inflammation Markers Associated with Multiple Peripheral Artery Occlusions in Elderly Patients.

Background: Pro-oxidative stress and pro-inflammatory responses can influence each other in the development of atherosclerosis. This study evaluated the relationship between oxidative stress, inflammation, and multiple peripheral artery occlusions in elderly patients (age mean 71.2 ± 8.1years). Methods: A total of 723 participants were enrolled: 67 healthy subjects, 214 patients with common iliac artery occlusions, 224 patients with popliteal artery occlusions, and 218 patients with femoral artery occlusions. We measured oxidative stress biomarkers (malondialdehyde [MDA], F2-isoprostane [F2-isoP], total oxidant status [TOS], and ischemia-modified albumin [IMA]) and the expressions of molecules in mimecan (MIME)/nuclear factor kappa B (NF-κB)/P53/Toll-like receptor 4 (TLR4) signaling pathway in older patients with multiple peripheral artery occlusions. Results: The levels of MDA, F2-isoP, TOS, IMA, MIME, NF-κB, P53, and TLR4 were increased in the single-site peripheral artery occlusive group when compared with healthy controls (P < .001) and were further increased in the multiple-site peripheral artery occlusive group compared with the single-site peripheral artery occlusive group (P < .001). Conclusion: Oxidative stress may promote inflammatory signaling pathways and lead to multiple peripheral artery occlusions in elderly patients.

Acute on Chronic Limb Ischemia Treatment: Case Series

ABSTRACT&#x0D; &#x0D; BACKGROUND: Acute on chronic limb ischemia is a condition caused by acute disruption in chronic vessel disease. The major cause is peripheral arterial disease or embolism. Treating the acute phase while considering the origin of disease is important to treat acute on chronic limb ischemia.&#x0D; CASE DESCRIPTION: 3 cases were described on this serial case report. The first and second case represent acute on chronic limb ischemia conditions with history of intermittent claudication (IC) and signs of acute limb ischemia (ALI) upon arrival. They were both treated with surgical intervention for ALI. Despite of adequate surgical intervention, both cases showed suboptimal limb recovery. Both patients were referred for further evaluation of chronic vessel disease with angiography. Third case represent chronic limb ischemia as end point of treatment from the first and second case. Patient with worsening IC despite adequate medical and exercise treatment underwent angiography examination. Angiography result found two sites of total occlusion of right common iliac artery and superficial femoral artery. Angioplasty and primary stenting were done on common iliac artery. Drug coated balloon and stenting was also performed on superficial femoral artery.&#x0D; CONCLUSION: Patients with acute on chronic limb ischemia need to be treated during acute phase and the remaining chronic vessel disease. Consideration and care should be taken when managing similar cases for optimal treatment.&#x0D; &#x0D; KEYWORDS: Acute on chronic limb ischemia, Thrombectomy, Angioplasty, Drug-coated Balloon.

Ближайшие и отдаленные результаты временной баллонной окклюзии общих подвздошных артерий при врастании плаценты

Objective. To study immediate and long-term results of endovascular reduction of blood flow in placental ingrowth. Patients and methods. The study included 70 pregnant women with ingrowth of the placenta into the uterine scar. The gestational age at time of delivery ranged from 30 to 40 weeks, averaging 35.8 ± 2.9 weeks. In all cases, the reduction of blood flow was performed using balloon catheters placed in the common iliac arteries. Admiral (Invatec) peripheral balloon catheters were used in 55 patients; in 15 patients – balloon catheters used in pediatric practice for dilatation of restrictive interatrial communication (Rashkind balloon). Results. There were no fatal outcomes. Endovascular complications were observed in 4 (5.7%) parturient women. In the longterm period the results were studied in 31 patients. In 22 (71%) patients menstrual function normalized within the first 3 months after the end of lactation. Recovery of menstrual function occurred in 3 (9.7%) women between 3 and 6 months, 2 (6.5%) cases each were in the subgroups with menstrual function recovery between 6 and 9 months and more than 9 months. Menstrual function was not recovered in 2 (6.5%) patients. Conclusion. Temporary balloon occlusion of the common iliac arteries significantly reduces the volume of blood loss, provides better visualization of the surgical area, and creates favorable conditions for subsequent pregnancy. Key words: balloon catheter, placental ingrowth, temporary occlusion of common iliac arteries, bleeding

A Case of Simultaneous Onset of Intra-abdominal Bleeding and Common Iliac Artery Occlusion due to Abdominal Trauma, which Could Be Saved and Attained Limb Salvage by Simultaneous Surgery of Abdominal Opening and Lower Limb Bypass after Creation of an External Shunt

A Case of Simultaneous Onset of Intra-abdominal Bleeding and Common Iliac Artery Occlusion due to Abdominal Trauma, which Could Be Saved and Attained Limb Salvage by Simultaneous Surgery of Abdominal Opening and Lower Limb Bypass after Creation of an External Shunt

Acute Limb Ischemia in a COVID-19 Patient: A Case Report

A 63-year-old man with a confirmed case of coronavirus disease 2019 and having complaints of severe pain and paralysis in his right lower limb was transported to our hospital in an ambulance. Because of thrombosis, a computed tomography angiogram revealed the occlusion of right common iliac artery and stenosis of abdominal aorta. Emergency angiography and thrombectomy were performed; after surgery, the patient was managed in the intensive care unit with mechanical ventilation and hemodialysis for renal failure. However, on postoperative day 7, thrombosis recurred, and he died because of multiple organ failure.

Fatal Aortoduodenal Fistula Caused by a Ruptured Abdominal Aortic Aneurysm - a Case Report

ABSTRACT Introduction: Ruptured abdominal aortic aneurysm (AAA) has a high mortality, even when the patients reach the hospital in time and the intervention is expeditious. Case presentation: We present the case of a 66-year-old male patient, with a known history of AAA, presenting to the emergency room in a state of hypovolemic shock due to massive bleeding in the upper and lower gastrointestinal tract and acute abdominal pain, which presented an abrupt onset one hour before presentation. The computed tomography angiography identified an aortoduodenal fistula with a trajectory toward the D3 segment of the duodenum, as well as a common iliac artery occlusion and extensive atherosclerotic stigmas. The patient was rushed to the operation room where he was resuscitated with intravenous fluids, two units of packed red blood cells, and hemostatic agents. The bleeding was stopped by clamping the aorta above the aneurysm. The duodenum was sutured, and the aorta was reconstructed with an aortobifemoral graft. Unfortunately, even though intensive care procedures continued for a few hours after surgery, all therapeutic efforts failed and the patient had succumbed.

ACUTE LIMB ISCHEMIA IN A YOUNG ADULT WITH COVID-19 INFECTION

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: COVID-19 infection is now well known to cause venous thrombotic complications. More recently, arterial thrombotic complications of COVID-19 have been reported. Incidence of Acute limb ischemia (ALI) ranges from 3 to 15%. CASE PRESENTATION: A 50-year-old male with a history of hypertension presented to the ED with left foot numbness, discoloration, and pain for 2 days. Two weeks before the presentation, he tested positive for SARS-CoV2 after an outpatient evaluation for acute cough. He did not have any other respiratory complaints and was quarantined at home. His cough persisted, but he denied any fever, shortness of breath, chest pain, or hemoptysis. On physical exam, he was afebrile, heart rate of 71 beats per minute, blood pressure 141/90 mm of Hg, respiratory rate of 19 breaths per minute, and oxygen saturation of 98% while breathing ambient air. His respiratory exam was unremarkable. There were no palpable femoral, popliteal, dorsalis pedis, and posterior tibial pulses on the left side. He had sensory loss in the left foot. Laboratory evaluation showed mild transaminitis. His CK was 767 U/L, and D-dimer was 4.92 mg/L. CTA abdominal aorta with iliofemoral runoff was performed, which showed partial occlusion of the distal abdominal aorta, near-complete occlusion of the left common iliac artery, and complete occlusion of the proximal popliteal artery at the level of the distal femur with no flow distal to this point.Anticoagulation with unfractionated heparin was initiated. The patient was emergently taken to the OR and underwent extensive embolectomy involving the aortoiliac, femoral, popliteal, and tibial artery of the left leg. Antiphospholipid antibodies were normal. He had no family or personal history of blood clots. His presentation was believed to be due to thrombotic complications of the COVID-19 infection. His postoperative course was unremarkable, and he was discharged home on postoperative day 5. DISCUSSION: ALI is a vascular emergency. The exact pathophysiology causing thrombosis is unknown, but endothelial dysfunction, cytokine production, acquired antiphospholipid syndrome, and hypoxia may contribute to thrombosis (1). The current prevalence of ALI is noted to be 4 to 21 per 100,000 COVID-19 hospitalizations. In one observational review and in most case series, the median age was over 60. Male sex, Hispanic ethnicity, history of myocardial infarction, CAD, and elevated D-dimer increase the risk of developing ALI (2). The patient usually presents with pain, pallor, numbness, and loss of pulses. CONCLUSIONS: We present a young patient with no significant risk factors and otherwise mild COVID-19 infection presenting with acute lower limb ischemia. A high index of suspicion and prompt recognition of ALI in patients with COVID-19 infection is critical. Surgical revascularization, either open or catheter-directed, and systemic anticoagulation is the mainstay of treatment. REFERENCE #1: Rahi MS, Jindal V, Reyes S-P, Gunasekaran K, Gupta R, Jaiyesimi I. Hematologic disorders associated with COVID-19: a review. Annals of Hematology. 2021. REFERENCE #2: Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. Jama. 2020. DISCLOSURES: No relevant relationships by Kwesi Amoah, source=Web Response No relevant relationships by Kavitha Gopalratnam, source=Web Response No relevant relationships by Kulothungan Gunasekaran, source=Web Response No relevant relationships by Lakshmi Polisetty, source=Web Response No relevant relationships by Mandeep Singh Rahi, source=Web Response

Trans-prosthetic recanalization of a collapsed iliac limb using the GoBack catheter: a case report

BackgroundRecanalization of graft limb occlusion can prove challenging and the use of the GoBack crossing and reentry device may be a suitable option, especially when there is no other way to restore flow with an usual endovascular approach. The GoBack catheter is a novel device designed to enhance pushability, and to enable direction-change inside hard plaques and crossing of tough lesions, even when they involve graft fabric.Case presentationIt’s reported a case of a 76-year-old male who presented with claudication, previous placement of an aorto-bi iliac graft by open surgery for a ruptured abdominal aneurysm 10 years ago that, over time, developed severe kinking on the left limb and a fabric occlusion on the right limb. After several unsuccessful attempts to cross the occlusion of the right common iliac artery, the GoBack™ was deployed to create a lumen through graft’s folds. After angioplasty and stenting a satisfactory result was achieved, restoring flowCT-scan at 1 month and duplex ultrasound (DUS) at 3 months confirmed the patency of ilio-femoral axis.ConclusionsThe advent of this new CTO crossing device has the potential to facilitate recanalization of some of the most challenging occlusions. Facilitating more consistent distal entry and allowing for a decrease in crossing time. Therefore, the GoBack catheter should be considered as a potential complementary tool to treat vascular occlusions via endovascular approaches, especially when classical endovascular techniques fail.

Endovascular Treatment of Aortic Bifurcation Occlusive Disease 10 Years After Open Surgical Repair of an Infrarenal Abdominal Aortic Aneurysm

A 74 year old man, a moderate smoker treated 10 years previously by open infrarenal abdominal aortic aneurysm tube graft, presented with left leg rest pain. (A) Computed tomography angiography revealed dilatation of the infrarenal aortic segment (31 mm) with a newly developed left common iliac artery occlusion and right common iliac artery sub-occlusion. (B) Two balloon expandable stents (8 × 59 mm; Omnilink Elite [Abbott Vascular, Santa Clara, CA, USA]) were deployed in a kissing stent configuration with good results and no complications. The patient received dual antiplatelet therapy for three months and after this period was asymptomatic.Image 1

COMPARATIVE STUDY BETWEEN TRANSBRACHIAL VS TRANSFEMORAL ANGIOPLASTY OF CHRONIC COMPLETE ILIAC ARTERY OCCLUSION

Background: Critical limb ischemia (CLI) is the most advanced stage of peripheral arterial occlusive disease; the prognosis is poor, with amputation rates up to 30 % and mortality up to 25% after 1 year. Objective: To compare between transbrachial approach and ipsilateral transfemoral approach either ultrasound guided or road map technique in common iliac artery occlusion angioplasty. Patients and Methods: A retrospective study conducted at the Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University Hospitals from January 2019 till October 2020. The 88 patients who are candidates for study were subdivided into to three groups: Group A: Including 31 patients for whom transbrachial iliac angioplasty, Group B: Including 30 patients for whom transfemoral ultrasound guided iliac angioplasty and Group C: Including 27 patients for whom transfemoral road map guided iliac angioplasty. All lesions were categorized according to the Trans-Atlantic Inter-Society Consensus II (TASC) classification. Results: Transbrachial success rate was 90.32% compared with 96.6 in transfemoral access. No statistical difference was found. Patency rate reached 90.3%, 90.0% and 85.2% in transbrachial, transfemoral ultrasound and transfemoral road map guided groups respectively (X2:0.462; P=0.794). Peri-procedural complication rate reached 16.1%, 6.7% and 74.1% in Tran brachial, transfemoral ultrasound and transfemoral road map guided groups, respectively. Complications were statistically higher significantly in transfemoral road map guided group (X2:0.462; P=0.794). Thirty days mortality rate reached 11.1%, 23.8% and 17.4% in Tran brachial, transfemoral ultrasound and transfemoral road map guided groups, respectively. This was not statistically different among the three access groups (X2: 1.362; P=0.506). Amputation rate reached 9.7%, 6.7% and 3.7% in transbrachial, transfemoral ultrasound and transfemoral road map guided groups, respectively. No statistically significant difference was found (X2: 6.207; P=0.145). Conclusion: The technical success of all approaches is high, with higher success rate in transfemoral access. While we found more bleeding complications with transfemoral access.

A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19).

BackgroundA systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease.Case summaryAn 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19.DiscussionCOVID-19 can have an atypical presentation with thrombosis at multiple sites.

Open versus endovascular REBOA control of blood loss during cesarean delivery in the placenta accreta spectrum: A single-center retrospective case control study

ObjectiveThe aim of this study was to compare two vascular control options for blood loss prevention and hysterectomy during cesarean delivery (CD22Cesarean delivery.): endovascular balloon occlusion of the aorta (REBOA33Resuscitative endovascular balloon occlusion of the aorta.) and open bilateral common iliac artery occlusion (CIAO44Common iliac artery occlusion.) in women with extensive placenta accreta spectrum (PAS55Placenta accreta spectrum.). Study designThis was retrospective comparison of cases of PAS using either CIAO (October 2017 through October 2018) or REBOA (November 2018 through November 2019) to prevent pathologic hemorrhage during scheduled CD. Women with confirmed placenta increta/percreta underwent either CD then intraoperative post-delivery, pre-hysterectomy open vascular control of both CIA66Common iliac artery. (CIAO group) or pre-operative, ultrasound-guided, fluoroscopy-free REBOA followed by standard CD and balloon inflation after fetal delivery (REBOA group). Intraoperative blood loss, transfusion volumes, surgical time, blood pressure, maternal and neonatal outcomes, hospitalization length and postoperative complications were compared. ResultsThe REBOA and CIAO groups included 12 and 16 women, respectively, with similar median age of 35 years and gestational age of 34–35 weeks. All REBOA catheters were successfully placed into aortic zone three under ultrasound guidance. The quantitated median intraoperative blood loss was significantly lower for the REBOA group, (541 [IQR 300–750] mL) compared to the CIAO group (3331 [IQR 1150−4750] mL (P = 0.001). As a result, the total volume of fluid and blood replacement therapy was significantly lower in the REBOA group (P < 0.05). Median surgical time in the REBOA group was less than half as long: 76 [IQR 64−89] minutes compared to 168 [IQR 90−222] minutes in the CIAO group (P = 0.001). None of the women with REBOA required hysterectomy, while 8/16 women in the CIAO group did (P = 0.008). Furthermore, the post-anesthesia recovery and hospital discharge times in the REBOA-group were shorter (P < 0.05). One thromboembolic complication occurred in each group. The only REBOA-associated complication was non-occlusive femoral artery thrombosis, with no surgical management required. No maternal or neonatal deaths occurred in either group. ConclusionFluoroscopy-free REBOA for women with PAS is associated with improved vascular control, perioperative blood loss, the need for transfusion and hysterectomy and reduces surgical time when compared to bilateral CIAO.