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García Martínez B, Calleja Hermosa P, Fernández Guzmán E, Jordá Lope J, Ballestero Diego R, Campos Juanatey F, Ramos Barseló E, Bustamante Sánchez SM, Gutiérrez Baños JL, Domínguez Esteban M. Arterial Fistulas in Urinary Diverted Patients: A Report of 5 Cases. Cardiovasc Intervent Radiol 2022; 45:1848-1854. [PMID: 36175658 DOI: 10.1007/s00270-022-03273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/26/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Arterio-urinary fistulae are a rare but potentially lethal complication that may arise after pelvic surgery, such as radical cystectomy. Historically, open surgery was the gold standard treatment, but currently endovascular treatment has gained prominence. METHODS We report our centre experience in endovascular treatment of cystectomy-related arterial fistulae and review the reported literature on the topic. During the postoperative period of radical cystoprostatectomy five patients presented different ranges of haematuria, and one presented rectal bleeding, four of them with haemodynamic instability. An urgent three-phase computed tomography was performed, showing active bleeding in 2 patients, while the rest of the patients presented indirect signs of fistulae. An angiography was performed, showing contrast extravasation in 60% of the cases and vessel wall irregularity in 40%. Five arteriourinary fistulae and one arterioenteric fistula were urgently treated with a covered stent placement, sealing the site of the fistula in the artery. RESULTS Immediate results were satisfactory in all cases; however, one patient died secondary to fistula-related causes 15 days post-treatment. No stent thrombosis or rebleeding have been registered during follow-up. In this review, reported results and complications after covered stent placement are shown, and controversial topics such as antibiotic coverage and antithrombotic treatment after endovascular treatment are also reviewed.
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Affiliation(s)
- Beatriz García Martínez
- Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain.
| | | | | | - Juan Jordá Lope
- Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain
| | | | | | | | - Secundino Manuel Bustamante Sánchez
- Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain
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Ghouti C, Leon G, Seddik S, Ait Said K, Vaudreuil L, Tillou X. Uretero-arterial fistula: Six new cases and systematic review of the literature. Prog Urol 2021; 31:605-617. [PMID: 34158218 DOI: 10.1016/j.purol.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 10/21/2022]
Abstract
AIM Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. METHODS Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords "arterio-ureteral fistula", "arterio iliac fistula" and "ilio-ureteral fistula". We excluded uretero-arterial fistula following vascular surgery. RESULTS Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. CONCLUSION SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. LEVEL OF PROOF 3.
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Affiliation(s)
- C Ghouti
- Urology department, University Hospital Caen, Caen, France
| | - G Leon
- Urology department, University Hospital Caen, Caen, France
| | - S Seddik
- Urology department, University Hospital Caen, Caen, France
| | - K Ait Said
- Urology department, University Hospital Caen, Caen, France
| | - L Vaudreuil
- Urology department, University Hospital Caen, Caen, France
| | - X Tillou
- Urology department, University Hospital Caen, Caen, France.
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Subiela JD, Balla A, Bollo J, Dilme JF, Soto Carricas B, Targarona EM, Rodriguez-Faba O, Breda A, Palou J. Endovascular Management of Ureteroarterial Fistula: Single Institution Experience and Systematic Literature Review. Vasc Endovascular Surg 2018; 52:275-286. [DOI: 10.1177/1538574418761721] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors’ hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review. Methods: Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: “uretero arterial fistula” and “uretero iliac fistula.” It includes only articles reporting the endovascular management. Results: Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1). Conclusion: Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.
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Affiliation(s)
- José D. Subiela
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Andrea Balla
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of General Surgery and Surgical Specialties “Paride Stefanini,” Sapienza, University of Rome, Rome, Italy
| | - Jesús Bollo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jaume F. Dilme
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Begoña Soto Carricas
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Eduard M. Targarona
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
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Quinlan MR, Costelloe J, Kelly S, Alawi M, Ahmed Z, Fennessy S, McDermott T, Egan B. Uretero-iliac artery fistula eight years after open abdominal aneurysm repair: A diagnostic and therapeutic challenge. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415816677502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- MR Quinlan
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - J Costelloe
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - S Kelly
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - M Alawi
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - Z Ahmed
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - S Fennessy
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - T McDermott
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
| | - B Egan
- The Adelaide and Meath Hospital incorporating The National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland
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Management Strategy for Ureteral-Iliac Artery Fistula. Ann Vasc Surg 2016; 36:22-27. [PMID: 27354319 DOI: 10.1016/j.avsg.2016.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/04/2016] [Accepted: 02/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ureteral-iliac artery fistula (UIAF) is a rare but a potentially life-threatening condition. In this study, we reported our results of UIAF treated by open surgical and endovascular treatment. METHODS In this single-center, retrospective observational cohort study, we reviewed 6 consecutive patients who were diagnosed with a UIAF and received either open surgical or endovascular treatment based on the specific risk profile of each patient. RESULTS All patients had an indwelling ureteral stent for a ureteral stricture, with an average ureteral stenting duration of 22 months (range, 1-74 months), and 2 patients had a history of endovascular treatment with stent grafts for UIAF. Contrast-enhanced computed tomographic angiography was positive in 4 patients. Blood and urine cultures were positive in 2 and 4 patients, respectively. Four patients, including 2 with previously failed endovascular treatment, received open surgical repair. The remaining 2 patients received either endovascular treatment with stent grafts or a hybrid procedure. During the mean follow-up period of 20.3 months (range, 6-29 months), there was no symptomatic recurrence of the UIAF. CONCLUSIONS A multidisciplinary approach is highly preferable for treating potentially life-threatening UIAF. Endovascular treatment with stent grafts is currently recommended in selected patients whenever possible, but open surgical treatment is required in certain patients with enteric contamination, abscess, local sepsis, or previously failed endovascular treatment.
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Maurice MJ, Cherullo EE. Urologic stenting-induced trauma: a comprehensive review and case series. Urology 2014; 84:36-41. [PMID: 24745795 DOI: 10.1016/j.urology.2014.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/08/2013] [Accepted: 01/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterize traumatic injuries secondary to ureteral stent manipulation and analyze factors associated with their occurrence. METHODS We performed a comprehensive retrospective review of the literature and of our institutional records for occurrences of iatrogenic injury because of retrograde ureteral stent procedures. RESULTS Overall, 22 cases were identified, including 3 cases at our institution. Most injuries involved a major artery (52%) or vein (30%), with the remainder (17%) limited to the genitourinary tract. Associated factors included: hydronephrosis, pelvic malignancy, indwelling or chronic ureteral stents, chemoradiation, and urinary diversion. CONCLUSION Ureteral stenting-induced trauma is a rare but potentially life-threatening event. Recognition of the risk factors that predispose patients to iatrogenic stent trauma may help to prevent such injuries or, alternatively, it may facilitate their prompt diagnosis and treatment.
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Affiliation(s)
- Matthew J Maurice
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Edward E Cherullo
- Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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Okada T, Yamaguchi M, Muradi A, Nomura Y, Uotani K, Idoguchi K, Miyamoto N, Kawasaki R, Taniguchi T, Okita Y, Sugimoto K. Long-term Results of Endovascular Stent Graft Placement of Ureteroarterial Fistula. Cardiovasc Intervent Radiol 2012. [DOI: 10.1007/s00270-012-0534-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Affiliation(s)
- M C McCullough
- Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, FL, USA
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Endovascular treatment of a right-sided ureteroiliac fistula in a patient with a simultaneous left-sided ureteroileal fistula. Case Rep Urol 2011; 2011:284505. [PMID: 22606609 PMCID: PMC3350230 DOI: 10.1155/2011/284505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/21/2011] [Indexed: 11/17/2022] Open
Abstract
We describe an 80-year-old female with a left ureteroileal fistula and simultaneously a right ureteroiliac fistula. Her history highlights the predisposing factors of radiation, major surgery in the region, and presence of bilateral double-J-stents. She was successfully treated with an endovascular approach after being initially misdiagnosed. There seems to be an increase in reporting ureteral fistulas, however this entity remains a rare clinical condition that can lead to life-threatening situations. A fast and accurate diagnosis of an ureteroarterial fistula remains a challenge.
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Gallo F, Gastaldi E, Spirito G, Barile A, Kosir C, Giberti C. A case of iliac-artery–ureteral fistula managed with a combined endoscopic approach. ACTA ACUST UNITED AC 2008; 5:225-8. [DOI: 10.1038/ncpuro1059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 01/24/2008] [Indexed: 11/09/2022]
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