Prophylactic preoperative balloon occlusion of hypogastric arteries in abnormal placentation; 5 years experience

Purpose

The purpose is to describe and evaluate the technique of prophylactic balloon occlusion of the anterior division of the internal iliac arteries (hypogastric arteries) in abnormal placentation.

Materials and methods

It is a retrospective study; the records of 44 patients with a diagnosis of placenta previa/accreta/percreta were retrospectively reviewed. Patients were divided into two groups. Thirty-two patients underwent prophylactic temporary balloon occlusion, followed by cesarean section. A review of cases was done over a period of 5 years. All cases after previous arrangement with the interventional radiologist and after admission, patient in the balloon occlusion group underwent the procedure of hypogastric artery balloon occlusion under fluoroscopy using minimal radiation exposure. Intra-operatively, the balloon was inflated as needed. Twelve patients underwent cesarean section without endovascular intervention. The following parameters were compared in the two groups: patient age, gravidity, parity, gestational age at delivery, pregnancy outcome, and days in the intensive care unit after delivery, total hospital days, volume of transfused blood products, operating room time, estimated blood loss, and postoperative morbidity and mortality.

Results

Patients in the balloon occlusion group had significantly less in estimated blood loss than the non balloon occlusion group. There was no statistical difference in mean volume of replaced blood products, operating room time or postoperative recovery time.

Conclusion

Our results support that in patients with placenta accreta/percreta, pre-operative prophylactic temporary balloon occlusion diminishes intra-operative blood loss. We conclude that balloon occlusion of the hypogastric arteries is safe and effective in an attempt to minimize blood loss in patients with abnormal placentation.     

Bilateral vertebral artery balloon occlusion for giant vertebrobasilar aneurysms

We describe the clinical presentation, radiological and clinical results in six consecutive patients with a giant vertebrobasilar aneurysm treated by bilateral vertebral artery balloon occlusion. Five patients presented with headache and signs of brain-stem compression and one with subarachnoid haemorrhage. In all patients vertebral artery balloon occlusion was performed. In four, this followed successful test occlusion. In one patient, who did not tolerate the test occlusion, a bypass from the external carotid to the posterior cerebral artery preceded definitive vertebral artery occlusion. One patient underwent bypass surgery prior to test occlusion. At 6–22 months follow-up three patients had a good functional outcome and showed unchanged size or shrinkage of the aneurysm on MRI. Three other patients died; one from recurrent haemorrhage, and two probably from delayed brain-stem ischaemia. The presence of two large posterior communicating arteries predicted good functional outcome, which was also related to the clinical condition at presentation, and the degree of brain-stem compression and oedema on MRI. Bilateral vertebral artery balloon occlusion can be considered in patients with otherwise untreatable giant vertebrobasilar aneurysms. If test occlusion is not tolerated, a surgical bypass to the posterior circulation can be considered. Received: 1 December 1999 Accepted: 6 October 2000     

Bilateral hypogastric artery occlusion in endovascular repair of abdominal aortic aneurysms and its clinical significance

PURPOSE: Endovascular treatment of aortoiliac aneurysms near or involving the hypogastric artery (HGA) requires HGA occlusion before endografting to avoid retrograde filling of the aneurysm. The purpose of this study is to evaluate clinical outcomes of bilateral HGA occlusion and determine if benefits gained by endovascular aneurysm repair (EVAR) outweigh the morbidity associated with the procedure. MATERIALS AND METHODS: Between 1999 and 2004, 128 patients with abdominal aortic aneurysm (AAA) were treated with bifurcated endograft placement. Bilateral coverage or embolization of HGAs was performed in 14 patients (10.9%). Embolization was achieved by deployment of coils and coverage was accomplished by extending the endoprosthesis into the external iliac artery. Clinical follow-up and computed tomographic angiography were performed at 1, 3, 6, 9, and 12 months and annually thereafter to detect potential aneurysm growth and endoleaks. RESULTS: During follow-up (range, 1-72 months), buttock claudication was noted in four patients (28.6%), including unilateral claudication in two and bilateral claudication in two. One patient experienced claudication longer than 12 months, which resolved within 18 months. De novo erectile dysfunction was seen in one patient, and pelvic ischemia was not found in any patient. There was no evidence of endoleak, aneurysm enlargement, or death associated with HGA occlusion. CONCLUSIONS: In our series, complications of bilateral HGA occlusion before EVAR were moderate and resolved over time. The benefits gained from EVAR outweigh the clinical problems caused by bilateral HGA occlusion, as there are no technical complications added to the EVAR procedure.     

MRI of pregnancy-related issues: abnormal placentation

OBJECTIVE: In this article, we review the clinical significance of abnormal placentation and the role of MRI in diagnosis and management of this potentially morbid condition. We present our clinical perspective on diagnosing this challenging problem with MRI and review the imaging findings that can lead to a correct diagnosis. CONCLUSION: As abnormal placentation becomes more prevalent, in large part due to the markedly rising rates of cesarean delivery, there is a need for accurate antenatal diagnosis of this condition to prevent maternal morbidity and mortality. Maternal and fetal outcomes can be optimized through multidisciplinary planning to achieve accurate diagnosis and anticipation of the extent of abnormal placentation in the antenatal period. Imaging findings of abnormal placentation have been described for both ultrasound and MRI, although limitations exist for each technique. Although ultrasound remains the primary screening modality for the detection of abnormal placentation, MRI is a complementary technique that should be considered when ultrasound is inconclusive or incomplete. Familiarity with MRI techniques to assess the placenta, MRI appearance of normal placenta, and imaging findings that suggest abnormal placentation can help radiologists contribute to a successful maternal outcome.     

Angioplasty-related iliac artery rupture: Treatment by temporary balloon occlusion

A case of nonsurgical treatment of common iliac artery rupture secondary to percutaneous transluminal angioplasty is reported.     

双侧髂内动脉、髂总动脉球囊阻断术辅助凶险性前置胎盘剖宫产临床效果对比

【摘要】 目的 比较双侧髂内动脉球囊阻断术和双侧髂总动脉球囊阻断术在凶险性前置胎盘剖宫产术中应用的临床效果。方法 回顾性分析2017年9月至2019年2月于徐州医科大学附属医院住院剖宫产分娩的64例凶险性前置胎盘产妇的临床资料。根据剖宫产术前介入术式不同,分为双侧髂内动脉球囊临时阻断术组（A组,n=45）和双侧髂总动脉球临时囊阻断术组（B组,n=19）。观察记录和比较两组剖宫产手术时间、透视时间、术中出血量和输血量、子宫切除率、术后住院时间、新生儿Apgar评分及手术相关并发症。结果 两组介入手术均获得成功。A组、B组平均透视时间分别为（194.58±77.41） s、（77.62±51.51） s,术中出血量分别为（1 522.22±831.18） mL、（1 042.11±478.79） mL,术中输血量分别为（986.67±739.04） mL、（715.79±433.67） mL,差异均有统计学意义（P＜0.05）;两组剖宫产手术时间、新生儿Apgar评分、术后住院时间、子宫切除率差异均无统计学意义（P＞0.05）。 结论 两种介入球囊阻断术均可有效减少凶险性前置胎盘产妇剖宫产术中出血量,双侧髂总动脉球囊阻断术操作更简单,且剖宫产术中透视时间和出血量更少,临床应用中更具有优势。     

Physical characteristics of balloon catheter systems used in temporary cerebral artery occlusion.

PURPOSETo compare and contrast the physical characteristics of balloon catheter systems used for temporary cerebrovascular occlusion.METHODCommonly used temporary occlusion systems were evaluated to determine: (a) balloon compliance; (b) balloon diameter versus volume; (c) balloon pressure versus volume; (d) simulated vessel wall pressure versus volume; (e) balloon failure volume; and (f) balloon deflation rate. Observations were made concerning construction differences that affect the potential safety of a balloon system or the way it is used.RESULTSThe nondetachable balloon system demonstrating the best compliance characteristics and lowest radial pressure generation was the nondetachable silicone balloon (Interventional Therapeutics Corporation, San Francisco, Calif). Diameter versus volume curves for all systems reveal an initial nonlinear expansion that could contribute to vessel overexpansion during occlusion.CONCLUSIONBalloon systems vary in construction, method of introduction, and compliance. Knowledge of these characteristics, as well as of nonlinear balloon expansion, should aid balloon selection and appropriate use while helping to minimize complications.     

Fogarty球囊导管取栓联合双侧髂动脉球囊阻断术治疗急性肾动脉血栓1例

1 临床资料 患者,男,75岁,因"突发右侧腰痛16 h"入院.16 h前患者无诱因下突发出现右侧腰痛,呈持续性钝痛,伴血压升高,最高血压:200/180 mmHg(1 mmHg=0.133 kPa).既往史:伴有高血压病史、房颤病史5年余.急诊主动脉CTA提示:右肾动脉未见显影,考虑闭塞(图1①).结合患者有房颤病史...     

Perfusion MR neuroimaging in patients undergoing balloon test occlusion of the internal carotid artery

BACKGROUND AND PURPOSE: We sought to investigate whether the combination of conventional, diffusion-weighted, and perfusion-weighted MR imaging increases the diagnostic accuracy of balloon test occlusion of the internal carotid artery. We describe perfusion anomalies and patterns of enhancement seen in areas of altered brain perfusion during MR-monitored temporary balloon occlusion of the internal carotid artery. METHODS: Nine patients underwent balloon occlusion testing under standard angiographic conditions with continuous clinical and EEG monitoring. One patient who failed the test by clinical criteria underwent an external carotid to internal carotid bypass operation, followed by a repeat balloon test occlusion, thereby bringing the total number of procedures to 10. Patients were further imaged at 1.5 T with perfusion- and diffusion-weighted imaging as well as with conventional noncontrast and contrast-enhanced turbo fluid-attenuated inversion recovery (FLAIR) and T1-weighted sequences. RESULTS: Seven of 10 patients who tolerated unilateral carotid test occlusion without adverse clinical neurologic or EEG changes exhibited delayed first-pass transit of contrast material through the affected cerebral hemisphere, indicative of altered perfusion without significant concurrent cerebral blood flow or blood volume changes. Four of these patients and both symptomatic patients showed pial or subarachnoid contrast staining in areas of altered perfusion without abnormalities on diffusion-weighted images. CONCLUSION: Our findings indicate that MR perfusion-weighted imaging is safe and easily accomplished in a high-field-strength magnet and that contrast-enhanced turboFLAIR imaging may provide clinically useful MR imaging evidence of abnormal cerebral blood flow and subclinical ischemia.     

髂内动脉球囊阻断应用于凶险性前置胎盘剖宫产术的围手术期护理

目的总结髂内动脉球囊阻断应用于凶险性前置胎盘剖宫产术中的围手术期的护理经验。 方法对16例凶险性前置胎盘行髂内动脉球囊阻断术患者给予围术期的全程管理,包括术前心理护理、多学科评估、术前准备及病情观察、术中辐射暴露风险防护及球囊导管护理、术后病情观察及术肢护理。 结果16例孕妇均顺利行髂内动脉球囊阻断及剖宫产术,均未发生手术相关并发症,新生儿出生时情况均良好。 结论通过精细化护理干预,能改善髂内动脉球囊阻断应用于凶险性前置胎盘剖宫产术的预后,为临床工作提供借鉴与参考。     

Intracavernous aneurysms: treatment by proximal balloon occlusion of the internal carotid artery

Seven patients with intracavernous aneurysms were treated by proximal balloon occlusion of the carotid artery, with no attempt to preserve carotid blood flow. After a 15-minute occlusion trial, two balloons were detached proximal to the neck of these aneurysms. Major clinical improvement occurred in six patients and no procedure-related complications were encountered (the follow-up period was 4-14 months). Because these aneurysms arise proximal to major collateral pathways, proximal carotid occlusions via endovascular techniques are simple and safe and carry with them little risk of thromboembolism.     

药物涂层球囊血管成形术治疗孤立性腘动脉慢性闭塞的近期效果

【摘要】 目的 评价药物涂层球囊（DCB）血管成形术治疗孤立性腘动脉闭塞性病变的近期临床效果。 方法 回顾性分析2018年1月至2019年6月期间经DCB成形术治疗的孤立性腘动脉慢性闭塞性病变患者临床资料。主要研究终点为靶病变1年初期通畅率,次要研究终点1年二期通畅率、保肢率和临床症状改善等。 结果 共入组31例患者36条患肢（左侧19条）,其中男20例;平均年龄72.7岁。14例患者16条患肢表现为重症肢体缺血（Rutherford分级4～6级）。手术技术成功率为83.3%（30/36）。6例患者靶病变需植入补救性支架,支架辅助技术均获成功。无患者发生远端动脉栓塞和腘动脉损伤,无死亡。平均随访7.8个月,有7例腘动脉再闭塞,其中3例系补救性支架植入患者,补救性支架再闭塞率为3/6。术后1年靶病变初期通畅率、二期通畅率分别为73.2%、83.6%,保肢率为86.1%,截肢/趾均发生于Rutherford分级6级患者。患肢平均踝-肱指数（ABI）由术前0.43上升至术后0.76,所有患者临床症状明显缓解。结论 DCB成形术治疗孤立性腘动脉慢性闭塞性病变安全,近期效果满意。补救性支架似并不能显著提高靶病变通畅率。     

颈内动脉球囊闭塞试验临床应用及研究进展

球囊闭塞试验（BOT）主要用于评估牺牲一侧颈内动脉的可行性。临床常用于侵犯颈内动脉的颅底、鼻咽、咽旁间隙、颈部原发或继发性肿瘤及颈内动脉复杂动脉瘤等治疗。目前不同术者在BOT麻醉方式选择、球囊类别选用、球囊闭塞位置、血流阻断时间及结果评判方法等方面存在差异。为了提高试验的准确性,又有静脉相延迟时间计算、残端压测定、低血压考验、脑灌注评估、局部脑氧饱和度监测、脑电图检查、经颅多普勒流速测定等多种BOT结果评判技术应用于临床。本文主要就这些方面的临床应用及研究进展进行综述。     

Superior mesenteric artery balloon occlusion. A nonoperative model of small bowel ischemia in dogs

The purpose of this study was to develop a nonoperative animal model of small bowel ischemia that could be used for subsequent studies of intestinal ischemia. Ten mongrel dogs underwent balloon occlusion of their superior mesenteric artery after percutaneous insertion of a balloon tipped catheter through the femoral artery. Small bowel biopsies taken at various time intervals demonstrated mucosal congestion, hemorrhage, and sloughing consistent with classic small bowel ischemia. These changes consistently began 3 hours after occlusion with transmural necrosis and perforation occurring by 18 hours after occlusion. Fluoroscopy demonstrated little or no flow in the mesenteric circulation during balloon occlusion. This model provides a standard nonoperative approach for the induction of intestinal ischemia in dogs and could be a valuable tool in the study of intestinal ischemia.     

Temporary balloon test occlusion of the internal carotid artery: experience in 500 cases.

PURPOSETo describe experience with 500 temporary balloon occlusions of the internal carotid artery, with particular emphasis on the techniques and complications.METHODSTemporary occlusion of the internal carotid artery was accomplished endovascularly using various balloon-catheter combinations. These temporary balloon occlusions were combined, when possible, with cerebral blood flow analysis with stable xenon-enhanced CT.RESULTSComplications related to this procedure occurred in 16 (3.2%) patients. Eight (1.6%) patients had asymptomatic complications. There were 8 who experienced neurologic changes. Six (1.2%) of these were transient; two (0.4%) were permanent. There were no deaths.CONCLUSIONSTemporary balloon occlusion of the internal carotid artery, believed helpful in identifying patients at risk of stroke during abrupt carotid artery sacrifice, can be performed with an acceptably low complication rate.