Comparative effectiveness evaluation of resuscitative endovascular balloon occlusion of the aorta (REBOA) and tourniquet hemostasis in organ-sparing surgery in patients with placenta accreta spectrum
Prikhodko A.M., Kan N.E., Amiraslanov E.Yu., Chuprynin V.D., Akinfiev D.M., Ketskalo M.V., Tyutyunnik V.L., Tsukanova A.A.
Objective. To assess the practical feasibility, safety, and changes in the volume of blood loss using REBOA in organ-sparing surgical management of placenta accreta spectrum (PAS).
Materials and methods. This retrospective comparative study evaluated the use of two consecutive clinical hemostasis methods in 32 pregnant women. The main group included 8 patients with PAS who underwent cesarean section using REBOA. The comparison group included 24 patients with PAS who underwent surgery using complex compression hemostasis. To ensure sample homogeneity, patients with histologically confirmed placenta accreta and placenta increta (excluding placenta percreta) were included in the comparison group. Statistical analysis was performed using the Mann-Whitney U test for quantitative variables and Fisher’s exact test for categorical variables. The null hypothesis was rejected at p<0.05.
Results. The following results were obtained in our study: the volume of intraoperative blood loss in the REBOA group was 725.0 [435.0–1100.0] mL versus 2225.0 [1575.0–2862.5] mL in the comparison group (p<0.001). The volume of autologous reinfusion in the REBOA group was 255.0 [250.0–362.5] mL versus 750.0 [537.5–842.5] mL in the comparison group (p=0.003). There were differences between the groups in duration of surgery – 82.50 [58.25–151.8] minutes in the main group and 151.0 [133.5–162.5] minutes in the comparison group (р=0.035). Hemoglobin levels on postoperative day 3 were 102.5 [97.0–108.0] g/L in the REBOA group and 92.5 [87.25–99.5] g/L in the comparison group (p=0.036). Hysterectomy was not performed in the REBOA group – 0/8, while in the comparison group it was performed in 6/24 women (p=0.241). No REBOA-related complications (vascular injury, limb ischemia, thrombosis) were registered.
Conclusion. This study demonstrated the practical feasibility and safety of REBOA. The preliminary findings of our study confirm the potential of REBOA to be used as a technique for pelvic devascularization in organ-sparing surgeries. However, further multicenter prospective studies with a larger sample size are needed to confirm the effectiveness of this technique.
Authors' contributions. Kan N.E., Prikhodko A.M., Tyutyunnik V.L. – study concept and design; Chuprynin V.D., Prikhodko A.M., Amiraslanov E.Yu. – material collection and processing; PrikhodkoA.M., Akinfiev D.M.– statistical analysis; Prikhodko A.M., Tsukanova A.A. – manuscript writing; Kan N.E., Prikhodko A.M., Tyutyunnik V.L., Ketskalo M.V. – manuscript editing.
Conflicts of interest. The authors declare no potential conflicts of interest related to publication of this article.
Funding. The study was conducted without any sponsorship.
Ethical Approval. The study was approved by the local Ethics Committee of V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia (protocol No. 2 of February 19, 2026).
Generative Artificial Intelligence. No generative AI was used in preparing this article.
Patient Consent for Publication. The patients have signed informed consent for publication of their data.
Authors' Data Sharing Statement. The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator.
For citation: Prikhodko A.M., Kan N.E., Amiraslanov E.Yu., Chuprynin V.D., Akinfiev D.M., Ketskalo M.V.,
Tyutyunnik V.L., Tsukanova A.A. Comparative effectiveness evaluation of resuscitative endovascular balloon occlusion of the aorta (REBOA) and tourniquet hemostasis in organ-sparing surgery in patients with placenta accreta spectrum.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (8): 83-92 (in Russian)
https://dx.doi.org/10.18565/aig.2026.106
Keywords
PAS
placenta accreta spectrum
REBOA
endovascular balloon occlusion of the aorta
tourniquet hemostasis
hemorrhage
organ-sparing surgery
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Received 01.04.2026
Accepted 22.05.2026
About the Authors
Andrey M. Prikhodko, Dr. Med. Sci., Deputy Director for Research at the Institute of Obstetrics, Head of the Department of Innovative Development, Associate Professor at the Department of Obstetrics and Gynecology, Associate Professor of the Russian Academy of Sciences, obstetrician-gynecologist at the 1st Maternity Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia,117997, Russia, Moscow, Ac. Oparin str., 4, +7(965)344-21-11, andrpri@mail.ru, https://orcid.org/0000-0002-6615-2360
Natalia E. Kan, Professor, Dr. Med. Sci., Deputy Director for Research – Director of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, kan-med@mail.ru, Researcher ID: B-2370-2015,
SPIN-code: 53788437, Authors ID: 624900, Scopus Author ID: 57008835600, https://orcid.org/0000-0001-5087-5946
Elrad Yu. Amiraslanov, PhD, Head of the Obstetric Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, eldis@mail.ru, https://orcid.org/0000-0001-5601-1241
Vladimir D. Chuprynin, PhD, Head of the Surgical Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, v_chuprynin@oparina4.ru, https://orcid.org/0000-0002-2997-9019
Dmitry M. Akinfiev, endovascular surgeon at the Radiology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, Author ID: 924170, https://orcid.org/0000-0003-4662-6757
Mikhail V. Ketskalo, PhD, Deputy Director, Director of the National Medical Research Center for Anesthesiology and Reanimatology for Pregnant Women,
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow,
Ac. Oparin str., 4, m_ketskalo@oparina4, https://orcid.org/0000-0001-6569-2106
Victor L. Tyutyunnik, Professor, Dr. Med. Sci., Leading Researcher at the Research and Development Service, Academician V.I. Kulakow National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str. 4, tioutiounnik@mail.ru, Researcher ID: B-2364-2015,
SPIN-code: 1963-1359, Authors ID: 213217, Scopus Author ID: 56190621500, https://orcid.org/0000-0002-5830-5099
Angelina A. Tsukanova, clinical resident, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparin str., 4, an-c-00@mail.ru, https://orcid.org/0009-0007-6827-8470
Corresponding author: Andrey M. Prikhodko, andrpri@mail.ru
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