Bilateral internal iliac artery ligation: the procedure of choice in life threatening postpartum haemorrhage

Background: The present study was to assess the indication and study the intraoperative and postoperative complications of bilateral internal iliac artery ligation. Aim of this study was to evaluate the effectiveness of internal iliac artery ligation in arresting postpartum haemorrhage.Methods: This is a retrospective study carried out between January 2015 to December 2018 at Shrimati Kashibai Navale Medical College and General Hospital, Pune. This study included 48 patients with life-threatening PPH. Bilateral internal iliac artery ligation was done by anterior approach in 7 patients and by posterior approach in 41 patients.Results: Intraoperative and postoperative complications were noted in all patients. Of the total patients, 10 required massive blood transfusion and 12 underwent obstetrical hysterectomies (n=12; 25%). Internal iliac vein injury was seen in 1 patient (n=1; 2.08%) and external vein thrombosis was noted in 3 patients (n=3; 6.25%). Maternal mortality was observed in 1 patient due to DIC on day 9 (n=1; 2.08%). The uterine salvage rate was 75%.Conclusions: Internal iliac artery ligation (IIAL) safe, rapid, effective, time tested method of controlling bleeding from genital tract.

Efficacy of internal iliac artery ligation for control of post-partum haemorrhage

Background: Pelvic hemorrhage is associated with a great degree of morbidity and mortality and has to be controlled immediately. Ligation of the internal iliac arteries is a method to achieve the goal. We conducted this study to assess the outcome, effectiveness and complications of internal iliac artery ligation (IIAL) in controlling postpartum haemorrhage.Methods: This study was a retrospective study conducted in a rural tertiary referral centre from April 2015 to March 2018. IIAL was performed in women with PPH either at caesarean section or at laparotomy performed at a variable time after vaginal or caesarean delivery.Results: Over the study period of 3 years, 29 cases of IIAL were performed. The most common indication for IIAL was atonic PPH. Uterine salvagability was 62% in this study.Conclusions: All obstetric surgeons should be fully aware of the indications, timing and technical aspects of IIAL. Bilateral internal iliac artery ligation remains a safe, fast, effective and life saving salvage procedure which should be encouraged and used routinely by obstetricians when faced with cases of severe obstetric hemorrhage, especially in young women of low parity.

Obstetric hysterectomy: a receding trend

Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed. Hemorrhage due to uterine atony, adherent placenta and PPH are still the causes of maternal death in developing countries. Although advances have been made in the development of conservative medical and surgical treatment of obstetric haemorrhage like brace sutures, internal iliac artery ligation, selective arterial embolization etc emergency obstetric hysterectomy remains a lifesaving procedure in the management of intractable haemorrhage unresponsive to conservative management.

Primary internal iliac artery ligation – an effective technique for surgical hemostasis in wertheim’s hysterectomy.

Objective: Lessening intra-operative blood loss by the technique of bilateral internal iliac artery ligation as 1st step in Wertheim’s Hysterectomy. Methods: 20 cases of early Stage Cancer Cervix, who underwent Wertheim’s hysterectomy over period June 09 to Dec 12 in CRG Hospital, Ujjain and Base Hospital Delhi Cantonment, were studied. The demographic data, hemoglobin before and after surgery, and requirement of intra-operative blood transfusion, were studied. Results : 80% patients had less than 200ml intra-operative blood loss. Conclusion : Alleviating troublesome bleeding during dissection of lymph nodes and ureteric tunnel by primary ligation of internal iliac artery is a statistically proven optimum technique of Wertheim’s Hysterectomy.

The Results of Simultaneous Bilateral Internal Iliac Artery and Inferior Mesecteric Artery Ligation during Open Abdominal Aortic Aneurysm Surgery

PURPOSE: Bilateral internal iliac artery (IIA) ligation with inferior mesenteric artery (IMA) ligation has been performed during open abdominal aortic aneurysm surgery and endovascular aneurismal repair (EVAR). We reviewed both the acute and long term effects of bilateral IIA ligation with IMA ligation. METHODS: A retrospective cross sectional review was performed on 315 patients who underwent open aneurysmal repair and EVAR between 1997 and 2008. Both IIAs of all the patients' were patent before aortic reconstruction. The patency of the IIAs and the presence of bowel ischemia was evaluated by the medical records on the operative findings, the sigmoidoscopy and the computed tomography. Telephone interviews were performed to assess buttock claudication. RESULTS: The mean age was 68.4 years and 259 patients were male. Unruptured aneurysm was found in 233 patients, ruptured aneurysm was found in 72 patients and impending rupture was found in 10 patients. Unilateral ligation of the IIA was required in 78 patients (24.8%), and bilateral ligation was performed in 43 patients (13.7%). Sigmoid colon ischemia occurred in 8 patients (2.5%), and the IIA was patent in 7 patients. Buttock claudication occurred in 10 out of 178 patients who were contactable on telephone, and the IIA was patent in 8 of these 10 patients. Bowel ischemia and buttock claudication were not significantly associated with the patency of the IIA (P>0.05). CONCLUSION: Bilateral IIA ligation with IMA ligation was able to be performed without significantly increasing the incidence of bowel ischemia and buttock claudication. Performing endovascular aneurysmal repair may be considered when bilateral graft extension to the external iliac artery is required.