{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T15:34:33Z","timestamp":1765812873996,"version":"3.48.0"},"reference-count":17,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Severe (FIGO grade 3b &amp; c) placenta accreta spectrum (PAS) is potentially a life-threatening condition due to catastrophic haemorrhage at delivery. Consequently, interventional radiology (IR) techniques are often employed to prevent massive blood loss, but this is not always readily available, is costly, and can cause significant morbidity, including distal limb ischaemia due to thrombus formation. We believe that internal iliac ligation under direct vision is a safe option to control bleeding. We sought to evaluate the short- and long-term outcomes relating to this technique compared to IR. Methods: This is a mixed-methods cohort study of women with severe PAS who underwent hysterectomy with either surgical devascularisation, as part of the Soleymani and Collins (SAC) technique, or IR insertion of internal iliac balloon catheters, in a UK tertiary referral centre for PAS between 2011 and 2022. Only women with intraoperative diagnosis of very severe PAS (FIGO stage 3b &amp; c) were included in this study. Results: Of the 22 women invited to participate in the long-term component of the study, 59% agreed. Women in the surgical devascularisation group experienced no adverse short or late sequelae related to internal iliac arterial ligation. Pelvic devascularisation (11 patients, 41%) demonstrated a reduction in median estimated blood loss, 1600 millilitres vs. 2500 millilitres in the IR balloon catheter group (p = 0.04). Conclusions: We have demonstrated that the SAC technique for surgical devascularisation is a safe method for achieving haemorrhage control during caesarean hysterectomy for severe PAS. It also appears to be at least as effective at haemorrhage control as IR balloon occlusion of the internal iliac vessels.<\/jats:p>","DOI":"10.3390\/diseases13120400","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T15:15:08Z","timestamp":1765811708000},"page":"400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Application of Stepwise Pelvic Devascularisation in the Management of Severe Placenta Accreta Spectrum as Part of the Soleymani and Collins Technique for Caesarean Hysterectomy: Surgical Description and Evaluation of Short- and Long-Term Outcomes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3293-5321","authenticated-orcid":false,"given":"Hooman","family":"Soleymani majd","sequence":"first","affiliation":[{"name":"Department of Gynaecology Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7LE, UK"},{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford OX2 6GG, UK"}]},{"given":"Lamiese","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK"}]},{"given":"Prasanna","family":"Supramaniam","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK"}]},{"given":"Aakriti","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2974-8181","authenticated-orcid":false,"given":"Annie E.","family":"Collins","sequence":"additional","affiliation":[{"name":"Medical Sciences Division, University of Oxford, Oxford OX1 2JD, UK"}]},{"given":"Lee","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK"}]},{"given":"Susan","family":"Addley","sequence":"additional","affiliation":[{"name":"University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8850-7436","authenticated-orcid":false,"given":"Alicia","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK"}]},{"given":"Lexie","family":"Pert","sequence":"additional","affiliation":[{"name":"Medical Sciences Division, University of Oxford, Oxford OX1 2JD, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2365-6769","authenticated-orcid":false,"given":"Theophilus","family":"Adu-Bredu","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford OX2 6GG, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-6594","authenticated-orcid":false,"given":"Pedro","family":"Pinto","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Ginecologia, ULS S\u00e3o Jo\u00e3o Faculdade de Medicina, Universidade do Porto, 4200-427 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5345-4688","authenticated-orcid":false,"given":"Ammar","family":"Al Naimi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Buergerhospital, 60318 Frankfurt, Germany"},{"name":"Department of Obstetrics and Perinatal Medicine, Goethe University Hospital of Frankfurt, 60596 Frankfurt, Germany"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2831-2134","authenticated-orcid":false,"given":"Jacopo","family":"Conforti","sequence":"additional","affiliation":[{"name":"Department of Gynaecology Oncology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7LE, UK"},{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy"}]},{"given":"Karin","family":"Fox","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 78229, USA"}]},{"given":"Sally L.","family":"Collins","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health, University of Oxford, Oxford OX2 6GG, UK"},{"name":"Birmingham Women\u2019s Hospital, Mindelsohn Way, Birmingham B15 2TG, UK"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/AOG.0000000000005229","article-title":"Placenta Accreta Spectrum","volume":"142","author":"Einerson","year":"2023","journal-title":"Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/ijgo.12410","article-title":"FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management","volume":"140","author":"Sentilhes","year":"2018","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1445","DOI":"10.1111\/aogs.14163","article-title":"Lack of experience is a main cause of maternal death in placenta accreta spectrum patients","volume":"100","author":"Osanan","year":"2021","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shamshirsaz, A.A., Fox, K.A., Salmanian, B., Diaz-Arrastia, C.R., Lee, W., Baker, B.W., Ballas, J., Chen, Q., Van Veen, T.R., and Javadian, P. (2015). Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am. J. Obstet. Gynecol., 212.","DOI":"10.1016\/j.ajog.2014.08.019"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1067\/j.cpradiol.2017.10.010","article-title":"Perioperative Internal Iliac Artery Balloon Occlusion, in the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist","volume":"47","author":"Petrov","year":"2018","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1055\/s-0043-1771038","article-title":"Placenta Accreta Spectrum: The Role of Interventional Radiology in Multidisciplinary Management","volume":"40","author":"Sanders","year":"2023","journal-title":"Semin. Interv. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1097\/AOG.0000000000001113","article-title":"Precesarean prophylactic balloon catheters for suspected placenta accreta: A randomized controlled trial","volume":"126","author":"Salim","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1515\/jpm-2022-0232","article-title":"Placenta Accreta Spectrum Part I: Anesthesia considerations based on an extended review of the literature","volume":"51","author":"Enste","year":"2022","journal-title":"J. Perinat. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/ijgo.12132","article-title":"Retrospective analysis of placenta previa with abnormal placentation with and without prophylactic use of abdominal aorta balloon occlusion","volume":"137","author":"Cui","year":"2017","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.21037\/qims-20-548","article-title":"The role of interventional radiology in the management of abnormally invasive placenta: A systematic review of current evidences","volume":"10","author":"Soyer","year":"2020","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"103594","DOI":"10.1016\/j.amsu.2022.103594","article-title":"Interventional radiology in low- and middle-income countries","volume":"77","author":"Jamil","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.ijoa.2013.11.002","article-title":"Sciatic nerve ischaemia after iliac artery occlusion balloon catheter placement for placenta percreta","volume":"23","author":"Teare","year":"2014","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.jclinane.2018.06.001","article-title":"Thrombosis and compartment syndrome requiring fasciotomy: Complications of internal iliac artery balloon catheters for morbidly adherent placenta","volume":"49","author":"Reddy","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Nabhan, A.E., AbdelQadir, Y.H., Abdelghafar, Y.A., Kashbour, M.O., Salem, N., Abdelkhalek, A.N., Nourelden, A.Z., Eshag, M.M.E., and Shah, J. (2022). Therapeutic effect of Internal iliac artery ligation and uterine artery ligation techniques for bleeding control in placenta accreta spectrum patients: A meta-analysis of 795 patients. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.983297"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1016\/j.ygyno.2016.12.019","article-title":"En-bloc resection of the pelvis (EnBRP) in patients with stage IIIC\u2013IV ovarian cancer: A 10 steps standardised technique. Surgical and survival outcomes of primary vs. interval surgery","volume":"144","author":"Tozzi","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Majd, H.S., Collins, S.L., Addley, S., Weeks, E., Chakravarti, S., Halder, S., and Alazzam, M. (2021). The modified radical peripartum cesarean hysterectomy (Soleymani-Alazzam-Collins technique): A systematic, safe procedure for the management of severe placenta accreta spectrum. Am. J. Obstet. Gynecol., 225.","DOI":"10.1016\/j.ajog.2021.03.014"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1177\/00031348221101509","article-title":"Complications Following Temporary Bilateral Internal Iliac Artery Ligation for Pelvic Hemorrhage Control in Trauma","volume":"88","author":"Schellenberg","year":"2022","journal-title":"Am. Surg."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/12\/400\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T15:32:14Z","timestamp":1765812734000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/12\/400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,15]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["diseases13120400"],"URL":"https:\/\/doi.org\/10.3390\/diseases13120400","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,15]]}}}