Prophylactic balloon occlusion of internal iliac arteries, common iliac
arteries and infrarenal abdominal aorta in pregnancies complicated
by placenta accreta: a retrospective cohort study
Received: 4 January 2018 / Revised: 21 April 2018 /Accepted: 3 May 2018
European Society of Radiology 2018
Objectives To evaluate the efficacy of prophylactic balloon occlusion (PBO), and to compare haemostatic effects and perioper-
ative outcomes of PBO of the internal iliac arteries (IIA), common iliac arteries (CIA) and infrarenal abdominal aorta (IAA) in
patients with placenta accreta.
Methods One hundred and ninety-nine patients with placenta accreta were retrospectively reviewed. One hundred and twelve
cases who underwent PBO were allocated into PBO group, and 87 cases without endovascular intervention were classified as the
control group. According to different methods, 112 patients in the PBO group were divided into IIA (n =37),CIA(n = 42) and
IAA (n = 33) subgroups.
Results Patients in the PBO group had decreased estimated blood loss (EBL) and blood transfusion volume (BTV), as well as
improved other perioperative outcomes. PBO (vs controls) could independently predict less EBL. As to comparison among subgroups,
patients had decreased EBL and BTV, as well as improved other perioperative outcomes in CIA and IAA subgroups compared to the
IIA subgroup. Further validation by multivariate analysis revealed that PBO of IIA (vs others) could independently predict more EBL.
Conclusions PBO reduces intraoperative blood loss and improves other perioperative outcomes in patients with placenta accreta,
and PBO of the CIA and IAA is more effective compared to PBO of IIA.
• PBO of IIA, CIA and IAA is effective in placenta accreta.
• PBO of CIA and IAA is more effective.
• PBO could independently predict less EBL.
• Accreta depth was an independent risk factor for EBL.
Keywords Balloon occlusion
BTV Blood transfusion volume
CIA Common iliac arteries
DAP Dose area product
EBL Estimated blood loss
IAA Infrarenal abdominal aorta
IIA Internal iliac arteries
PBO Prophylactic balloon occlusion
Placenta accreta is considered as a complication of human
placentation, which is defined as an abnormal and firm adher-
ence of all or part of the placenta to the uterine wall .
According to invasion depth, placenta accreta is classified into
three subtypes including placenta accreta, increta and percreta,
which indicates chorionic villi attachment to the myometrium
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-018-5527-7) contains supplementary
material, which is available to authorized users.
* Yu Zou
Department of Radiology, Women’s Hospital, School of Medicine,
Zhejiang University, 1# Xueshi Road, Hangzhou, Zhejiang 310006,
Department of Obstetrics, Women’s Hospital, School of Medicine,
Zhejiang University, Hangzhou 310006, Zhejiang, China