We read with interest the editorial by Heidemann
1
and article by Wei et al.
2
regarding radiological intervention in abnormally invasive placenta (AIP). We strongly
believe that in this instance maternal risks, such as lower limb ischemia, renal failure
from renal artery occlusion, unknown consequences of radiation exposure and significant
increase in arterial pressure associated with prophylactic abdominal aortic balloon
occlusion (PABO), outweigh the benefits of reduced blood loss and fertility sparing
in electively-managed AIP cases in a tertiary care hospital with adequate resources.To read this article in full you will need to make a payment
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References
- Interventional radiology for abnormally invasive placenta: do we need an alternative?.Int J Obstet Anesth. 2016; 27: 1-2
- Prophylactic abdominal aorta balloon occlusion during cesarean section: a retrospective case series.Int J Obstet Anesth. 2016; 27: 3-8
- Use of an intra-aortic balloon catheter tamponade for controlling intraabdominal hemorrhage in man.Surgery. 1954; 36: 65-68
- The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute care surgery (AORTA) registry: data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA).J Trauma Acute Care Surg. 2016; 81: 409-419
- Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta.J Trauma Acute Care Surg. 2015; 78: 897-903
- Current opinion on catheter-based hemorrhage control in trauma patients.J Trauma Acute Care Surg. 2014; 76: 888-893
- Balloon-assisted occlusion of the internal iliac arteries in patients with placenta accreta/percreta.Cardiovasc Intervent Radiol. 2006; 29: 354-361
- Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: literature review and analysis.Clin Radiol. 2012; 67: 515-520
- Design of a cost-effective, hemodynamically adjustable model for resuscitative endovascular balloon occlusion of the aorta (REBOA) simulation.J Trauma Acute Care Surg. 2016; 81: 606-611
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Published online: September 23, 2016
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- Prophylactic abdominal aorta balloon occlusion during cesarean sectionInternational Journal of Obstetric AnesthesiaVol. 30
- PreviewI would like to thank Drs Bullough and Kim for their letter.1 Their response seems partially based on a misunderstanding that the editorial,2 whilst mentioning the use of prophylactic aortic balloon occlusion, did not advocate its use. With more modern equipment available, it is possible to place a femoral arterial sheath which, if major incompressible haemorrhage occurs, allows placement of an aortic balloon occlusion catheter. It is the same way that in my institution internal iliac balloon catheters, placed by an interventional radiologist, are currently used.
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