Intra-Operative Multivessel Embolization Reduces Blood Loss and Transfusion Requirements Compared to Internal Iliac Artery Balloon Placement During Cesarean Hysterectomy for Placenta Accreta Spectrum

To evaluate efficacy and safety of prophylactic multivessel vessel embolization (MVE) compared to internal iliac artery occlusion balloon (IIABO) placement for patients undergoing cesarean hysterectomy for placenta accreta spectrum (PAS). An IRB approved retrospective series was performed of consecutive patients with PAS at a single institution between 2010-2021. MVE was performed in a hybrid operating room after cesarean section prior to hysterectomy. IIABO was performed with balloons placed into the bilateral internal iliac arteries which were inflated during hysterectomy. Median blood loss, transfusion requirements, percentage of cases requiring a transfusion, and adverse events were recorded. A total of 20 patients treated with embolization and 34 patients with balloons were included. Placenta percreta and previa were seen in 60% and 90% of patients, respectively. Median blood loss was 713 mL (interquartile range, 475 - 1000) with MVE compared to 2000 mL (1500- 2425) in the IIABO group (P < .0001). The median total number of units of packed red blood cell transfusions (0 vs 2.5) and the percentage of cases requiring a transfusion (20 vs 65%) were less in the MVE group (P < 0.01). A median of 4 vessels (3-9) were embolized during MVE. No major complications or non-target embolization consequences were observed. Prophylactic multi vessel embolization is a safe procedure which reduces operative blood loss and transfusion requirements compared to IIABO in patients undergoing cesarean hysterectomy for presumed higher degree PAS. [Display omitted] •Compared to internal iliac balloon occlusion catheters, multivessel embolization after cesarean section prior to hysterectomy reduces operative blood loss by over half, and reduces transfusion requirements, and ICU/hospital lengths of stay in patients with higher degree placenta accreta spectrum.•These improved outcomes were at the cost of increased fluoroscopic times, contrast usage, and complexity as these procedures had to be performed intra-operatively in a hybrid operating room compared to an angiography suite.•No differences between complication rates or clinically significant non-target embolization were observed.