Temporary Endovascular Balloon Occlusion of the Internal Iliac Arteries to Prevent Hemorrhage During Uterine Cervical Myomectomy

Abstract

Cervical myomectomy carries a significant risk of hemorrhagic complications. Herein, we describe a prophylactic procedure—temporary endovascular balloon occlusion of the internal iliac arteries—that can be used to prevent excessive bleeding during surgical removal of a huge uterine cervical myoma. Endovascular occlusion catheters are placed in both internal iliac arteries. During myomectomy, the balloons are inflated to occlude these vessels. Upon completion of the surgery, and thus after the myometrium is sutured, the balloons are deflated, hemostasis is confirmed, and the catheters are removed. Thus far, we have used this method to reduce blood loss in 16 patients undergoing cervical myomectomy, and there has been no adverse effect. We have found the procedure, which we describe in detail, to be useful not only for the patients undergoing simple cervical myomectomy but also for the patients requiring cervical myomectomy concomitant with hysterectomy.