Fogarty balloon and conventional balloon for occlusion of internal iliac artery during caesarean section for pernicious placenta previa / 中国介入影像与治疗学

ABSTRACT

Objective To compare the application value of Fogarty balloon and conventional balloon for occlusion of internal iliac artery during caesarean section for pernicious placenta previa (PPP). Methods: Data of 57 pregnant women with PPP were retrospectively analyzed. The patients were divided into group A (n=27, using Fogarty balloon) and group B (n=30, using percutaneous transluminal angioplastry [PTA] conventional balloon)for internal iliac artery occlusion. The balloons were placed into bilateral internal iliac arteries before cesarean section. After the delivery of fetus, the balloons were dilated. Whether the balloons were deflated immediately depended on the amount of intraoperative bleeding after complete separation of placenta. The patients were treated with DSA-guided uterine artery embolization, hysterectomy or transferred into intensive care unit (ICU) after cesarean section if necessary. The clinical outcomes were analyzed and classified into good (discharge smoothly after cesarean section) and poor (occurring postoperative complications, needing uterine artery embolization, hysterectomy or getting ICU admission). The differences of duration time of cesarean section, intraoperative bleeding volume, blood transfusion, uterine artery embolization, duration of hospitalization and clinical outcomes were statistically compared between the two groups. Results: The duration time of cesarean section of group A was significantly shorter than that of group B ([72.37±17.39]min vs [86.93±27.79]min, t=-2.40, P=0.02). The proportion of transfusion of group A was lower than that of group B (44.44% [12/27]) vs 73.33% [22/30], χ2=4.93, P=0.03). The intraoperative bleeding volume (500[300]ml vs 700[150]ml, U=190, P<0.01) and the blood transfusion volume (0 [400]ml vs 400 [800]ml, U=249, P=0.01) of group A were significantly lower than those of group B. There was no significant difference of uterine arterial embolization (χ2=1.52, P=0.22), duration of hospitalization (t=-0.12, P=0.91)nor clinical outcomes (χ2=1.38, P=0.24) between the two groups. Conclusion: Compared with PTA conventional balloon, Fogarty balloon is more effective in blocking internal iliac artery blood flow during cesarean section, which can further reduce the volume of intraoperative bleeding and shorten the duration of cesarean section.