Placenta accreta syndrome results from the abnormal adherence of the placenta to the myometrium due to the absence of the decidua basalis and imperfect development of the Nitabuch layer. It causes serious obstetric morbidity due to the risk of massive hemorrhage. Balloon occlusion of internal iliac arteries has been used prophylactically to decrease hemorrhage in cesarean hysterectomy for placenta accreta. In this paper, two cases of placenta accreta syndromes wherein bilateral internal iliac artery balloon occlusion was done prior to cesarean hysterectomy are presented. Case 1 is a 50-year-old G4P0 (0030) pregnancy uterine who came in at 33 3/7 weeks age of gestation for fetal surveillance. Case 2 is a 38-year-old G4P2 (2012) pregnancy uterine who came in at 33 4/7 weeks age of gestation for decreased fetal movement. Both cases were successfully delivered via cesarean hysterectomy with prophylactic balloon occlusion under a multidisciplinary team in a tertiary care center.
Balloon Occlusion ; Placenta Accreta

In the management of carotid cavernous fistula, detachable balloon has become the treatment of choice.However, technical difficulties are not uncommon, and transarterial balloon embolization fail in 5% to 10% ofcases. Failure occurs because in some patients, the fistula orifice may be too small to allow entry. Using atracker catheter system with Guglielmi detachable coils, we achieved successful transarterial occlusion of acarotid cavernous fistula with a small fistula.
Balloon Occlusion ; Catheters ; Fistula* ; Humans

Carotid-cavernous fistula is a serious complication of head trauma. We have experienced 5 cases of carotid-cavernous fistula(four cases were traumatic and one was spontaneous) recently and have successfully managed them by detachable balloon occlusion. We have found that while some cases had typical manifestations, the others had atypical features. We therefore concluded that clinical suspicion and early imaging studies are essential steps in the management of carotid-cavernous fistula. Careful monitoring and prompt treatment are important because of its dismal progression and poor outcome. Detachable balloon occlusion is a method of choice in management of carotid-cavernous fistula, because it can be used under local anesthesia. It provides a chance of early detection of neurological deterioration during the procedure and it can be, if necessary performed during diagnostic procedures.
Anesthesia, Local ; Balloon Occlusion* ; Craniocerebral Trauma ; Fistula*

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.
Balloon Occlusion ; Carotid Artery, Internal ; Fistula* ; Humans ; Ligation ; Veins

Balloon Occlusion ; Esophageal and Gastric Varices ; Humans ; Polyethylene Glycols ; Sclerotherapy

Angioplasty, Balloon, Coronary ; Chronic Disease ; Coronary Occlusion ; therapy ; Humans

Distal embolization, such as plaque debris and thrombus during percutaneous coronary and carotid interventions, often lead to virtually untreatable small vessel occlusions and the no-reflow phenomenon, which may cause periprocedural end organ ischemia and infarction. This is clinically important as the one-year mortality is doubled in patients with a periprocedural myocardial infarction. To prevent a distal embolization a number of distal protection devices have been developed, with others still under development, such as a balloon occlusion device (PercuSurge GuardWire), numerous filter devices (FilterWire EX, AngioGuard, Mednova Neuroshield, AccuNet) and a catheter occlusion device (Parodi Anti-Emboli System). The usefulness and roles of distal protection devices, for cardiovascular intervention, are reviewed.
Angioplasty, Balloon ; Balloon Occlusion ; Catheters ; Humans ; Infarction ; Ischemia ; Mortality ; Myocardial Infarction ; No-Reflow Phenomenon ; Thrombosis

BACKGROUND AND OBJECTIVE: Percutaneous transluminal coronary angioplasty of chronic total occlusion has been limited by a relatively low success rate and a high restenosis rate. This study investigated procedural outcome, factors predictive of procedural success and safety of coronary angioplasty for chronic total coronary occlusion. MATERIALS AND METHODS: The study population was composed of 45 lesions attempting PTCA with or without stent implantation for recanalization of chronic total coronary occlusion between January 1997 and July 1999. The clinical and angiographic data of the 45 lesions were reviewed. The results of successful PTCA in 28 lesions were compared with those in 17 lesions whose PTCA was failed. RESULTS: The overall success of balloon angioplasty and stenting was achieved in 28 lesions (62.2%) and did not differ significantly by clinical variables. The most common cause of failure of balloon angioplasty was inability to pass the guide wire across the occlusion( 14 of 23 lesions, 61%). Procedural success was more common in patients with occlusions with a tapered entry configuration(77.2% vs. 47.8%, p=.042), with lesions without side branches(82.3% vs. 50%, p=.03). Multiple logistic regression analysis identified the absence of side branch(p<0.01) and the presence of a tapered entry configuration(p<0.05) as independent predictors of procedural success. One case(2.2%) needed emergency coronary bypass surgery after failure to recanalize the occluded vessel. There was no Q wave acute myocardial infarction, death. CONCLUSIONS: The favorable cases(>60%) of chronic total coronary occlusions can be successfully dilated by balloon angioplasty with or without stent implantation, with a major complication rate of 2.2%. Therefore, with careful patient selection, we need to try the aggressive recanalization for chronic total coronary occlusion.
Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary* ; Coronary Occlusion ; Emergencies ; Humans ; Logistic Models ; Myocardial Infarction ; Patient Selection ; Stents

Balloon tamponade using Sengstaken–Blakemore (SB) tube is employed as a bridging therapy in cases in which endoscopic therapy fails to control esophageal variceal bleeding. Although SB tube insertion can lead to successful hemostasis, it is accompanied by numerous complications, with SB tube transection being one of the rarest complications. A 53-year-old man with liver cirrhosis and hepatocellular carcinoma presented with massive esophageal variceal bleeding. Therapeutic endoscopic variceal ligation failed, and SB tube was inserted. The SB tube was unexpectedly disconnected because of the patient's irritability due to hepatic encephalopathy. The esophageal and gastric balloon of the SB tube remained inflated in the stomach. Whereas the use of other endoscopic instruments was ineffective, endoscopic removal was successfully accomplished using endoscopic scissors. In conclusion, we detected SB tube transection in a patient with hepatic encephalopathy and removed remnants of the inflated tube using endoscopic scissors.
Balloon Occlusion ; Carcinoma, Hepatocellular ; Esophageal and Gastric Varices ; Gastric Balloon ; Hemostasis ; Hepatic Encephalopathy ; Humans ; Ligation ; Liver Cirrhosis ; Middle Aged ; Stomach

BACKGROUND AND OBJECTIVES: Small myocardial infarction (MI) has been reported in 8 - 20% of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). But neither appropriate threshold of cardiac enzyme nor useful biochemical marker for its detection has not yet been fully defined. We examined the cardiac enzyme to define more valuable biochemical marker for the detection of small MI after PTCA and to evaluate factors associated with small MI after PTCA. MATERIALS AND METHODS: This study population consisted of 209 consecutive patients who underwent PTCA. Cardiac enzyme levels were measured before and 8, 24 hours after PTCA for CK-MB, and before and 16 hours after PTCA for troponin T. We defined small MI when CK-MB levels were over 16U/L and/or troponin T levels were over 0.2 ng/ml. RESULTS: Incidence of small MI after PTCA was 28/209 (13.4%) and the most of those were non-Q MI (24/28, 86%). In the detection of small MI after PTCA, the sensitivity of troponin T was higher than CK-MB (92.9% vs 39.3%). Major complications (major dissection, acute coronary occlusion, and side branch occlusion) developed significantly more in patients with small MI than in patients without small MI (p=0.002). Three independent variables, which were significantly associated with small MI after PTCA, were age, total/subtotal occlusion, and acute coronary occlusion as complication (p=0.01, p=0.02, and p=0.04, respectively). CONCLUSIONS: Troponin T is more sensitive biochemical marker than CK-MB in the detection of small MI after PTCA. Major complications of angioplasty are frequently associated with small MI. Especially, age, total occlusion, and acute coronary occlusion as complication are independent factors significantly associated with small MI after PTCA.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Biomarkers ; Coronary Occlusion ; Humans ; Incidence ; Myocardial Infarction ; Troponin T* ; Troponin*