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CORRESPONDENCE| Volume 20, ISSUE 3, P266, July 2011

Proximal vascular control in cases of abnormal placentation

      I read with interest the paper by Thon et al. describing the use of prophylactic internal iliac occlusion balloon catheters in parturients with placenta accreta.
      • Thon S.
      • McLintic A.
      • Wagner Y.
      Prophylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series.
      The pelvic collateral system is highly interconnected with aortic, internal iliac, external iliac and femoral components.
      • Hassen-Khodja R.
      • Batt M.
      • Michetti C.
      • Le Bas P.
      Radiologic anatomy of the anastomotic systems of the internal iliac artery.
      Most abnormal placentation occurs in the lower uterine segment for which the main blood supply is by collaterals from the internal pudendal artery.
      • Palacios-Jaraquemada J.M.
      • García-Mónaco R.
      • Barbosa N.E.
      • Ferle L.
      • Iriarte H.
      • Conesa H.A.
      Lower uterine blood supply: extrauterine anastomotic system and its application in surgical devascularization techniques.
      The latter usually arise from the posterior division of the internal iliac artery, so occlusion of the anterior division of the internal iliac artery is unlikely to have a hemostatic effect in abnormal lower uterine abnormal placentation.
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      References

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        • McLintic A.
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        Prophylactic endovascular placement of internal iliac occlusion balloon catheters in parturients with placenta accreta: a retrospective case series.
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        Lower uterine blood supply: extrauterine anastomotic system and its application in surgical devascularization techniques.
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