Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta

Abstract

The increasing incidence of morbidly adherent placenta (MAP) is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic iliac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal iliac artery balloons who had external iliac artery thrombosis detected by computed tomography angiography (CTA) 72 h post cesarean section. A digital subtraction angiogram (DSA) and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic iliac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy.

概要

目的

球囊预置术的在产科领域的应用缺乏指南规范,该病例分析和文献汇纳分析将为该技术在产科临床应用中的利弊和并发症防治提供参考指导。

创新点

首例报道介入溶栓成功治愈预置球囊术在凶险性前置胎盘应用中诱发的动脉血栓。

方法

结合病例报道和文献汇纳分析。患者女,25 岁,入院诊断:(1)G3P2(1-1-0-1)孕29⁺² 周单活胎,(2)产前出血原因为凶险性前置胎盘,(3)疤痕子宫,(4)先兆早产。孕33 周后实施双侧髂内动脉球囊置入术后行子宫下段剖宫产术。剖宫产术后第3 天,计算机断层扫描血管造影术(CTA)明确诊断“右髂外动脉血栓,右髂总动脉夹层”,立即行数字减影动脉造影(DSA)+介入溶栓术+药物巩固治疗。无并发症出院,随访无后遗症。

结论

球囊预置术在胎盘植入中的应用尚无指南遵循,有效性尚存争议,安全性有待明确,需要各中心的数据汇纳和经验集享,以规范该技术的最益化应用。球囊预置术导致血栓形成的并发症处理,需要根据病情及时采取个体化治疗方案:介入溶栓、动脉取栓、药物抗凝、期待治疗或者综合治疗等。