Izbizky Gustavo, Meller César, Grasso Mario, Velazco Andrea, Peralta Oscar, Otaño Lucas, Garcia-Monaco Ricardo
Obstetrics Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
Gynecology Service, Hospital Italiano de Buenos Aires, JD Peron 4190 (C1199ACI), Buenos Aires, Argentina.
J Vasc Interv Radiol. 2015 Feb;26(2):162-9; quiz 170. doi: 10.1016/j.jvir.2014.10.013. Epub 2014 Dec 17.
To evaluate the feasibility and safety of prophylactic uterine artery catheterization and embolization in the management of placenta accreta (PA).
Retrospective chart review was performed of 95 consecutive patients with prenatal suspicion of PA managed in a 10-year period with a strategy that included prophylactic bilateral uterine artery catheterization, delivery of the baby, uterine artery embolization if indicated, and subsequent surgery. Feasibility was defined as catheterization being possible to perform, technical success as embolization being possible when indicated and complete stasis of the vessels achieved, and clinical success as no maternal death or major blood loss. Median gestational age at delivery was 36 weeks (interquartile range, 24-39 wk).
PA was confirmed in 79 patients (83%). Feasibility was 97% (92 of 95); in three cases (3%), acute early massive hemorrhage forced emergency delivery without catheterization. Embolization was performed in 83 of 92 patients (87%) to the extent of complete stasis; in the remaining nine, it was unnecessary because spontaneous placental detachment was visualized after fetal delivery (technical success rate, 100%). There were several complications, including bleeding requiring blood transfusion (49%) and bladder surgery (37%), but there were no major complications attributable to the endovascular procedures. There was one minor complication presumably related to embolization (transient paresthesia and decreased temperature of lower limb), with uneventful follow-up. Clinical success rate was 86%, with no maternal deaths, but 14% of patients received large-volume blood transfusion.
Prophylactic uterine artery catheterization and embolization in the management of PA appeared to be feasible and safe in this consecutive series of patients.
评估预防性子宫动脉插管和栓塞术在胎盘植入（PA）管理中的可行性和安全性。
对连续95例产前疑似PA的患者进行回顾性病历审查，这些患者在10年期间接受了包括预防性双侧子宫动脉插管、分娩、必要时进行子宫动脉栓塞及后续手术的治疗策略。可行性定义为能够进行插管，技术成功定义为必要时能够进行栓塞且实现血管完全闭塞，临床成功定义为无孕产妇死亡或大量失血。分娩时的中位孕周为36周（四分位间距，24 - 39周）。
79例患者（83%）确诊为PA。可行性为97%（95例中的92例）；3例（3%）因急性早期大量出血被迫紧急分娩而未进行插管。92例患者中的83例（87%）进行了栓塞，达到完全闭塞；其余9例因胎儿分娩后可见胎盘自发剥离而无需栓塞（技术成功率为100%）。有多种并发症，包括需要输血的出血（49%）和膀胱手术（37%），但没有归因于血管内操作的重大并发症。有1例可能与栓塞相关的轻微并发症（短暂性感觉异常和下肢温度降低），随访情况良好。临床成功率为86%，无孕产妇死亡，但1�%的患者接受了大量输血。
在这一系列连续患者中，预防性子宫动脉插管和栓塞术在PA管理中似乎是可行且安全的。
