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The placenta accreta spectrum (PAS) includes various types of abnormal adherence, posing significant hemorrhage risks in pregnancies, often requiring cesarean hysterectomy. Aims and objectives: To report a rare complication following internal iliac artery balloon occlusion in a placenta percreta case managed with planned cesarean hysterectomy, emphasizing detection and management of procedural complications to enhance maternal outcomes. Case Details: A 27-year-old G3P2LIUFDI with prev 2 LSCS female with placenta accreta spectrum (PAS) disorder was admitted at 34 weeks gestation for planned delivery. Preoperative bilateral internal iliac artery cannulation was performed by an interventional radiologist under aseptic conditions to reduce hemorrhage risk during cesarcan hysterectomy. Bilateral femoral artery access was gained, and arterial balloon occlusion with Swan-Ganz catheters was performed before surgery. During Surgery significant PAS involvement was observed and obstetrical hysterectomy was done after balloon occlusion post delivery of the baby. Post surgery anaesthetists observed absent dorsalis pedis over right lower limb Observations indicated cold, pulseless lower limbs Prompt intervention with doppler and Emergency thromboaspiration removed the thrombus, restoring vascular flow was done however the patient had intermittent claudication persisted, requiring further thrombectomy. Postoperative monitoring and anticoagulant therapy led to successful recovery, with patient discharge on day 22. Conclusion-Arterial balloon occlusion can effectively reduce hemorrhage in PAS cases, yet thrombotic complications, though rare, necessitate vigilant monitoring. Early detection and immediate thrombus removal are crucial for patient recovery. Systematic monitoring of pedal pulses post-occlusion is recommended for timely complication management.