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Lee S, Mo H, Jung IM. Infection of the Aortic Stent Graft to Treat Arterioureteral Fistula. Vasc Specialist Int 2023; 39:38. [PMID: 37990517 PMCID: PMC10663726 DOI: 10.5758/vsi.230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 11/23/2023] Open
Abstract
Arterioureteral fistula is a rare but life-threatening condition. An endovascular treatment approach is commonly used; however, there is a potential risk of infection. We present a case in which a patient presented with abdominal pain and was diagnosed with a ruptured internal iliac artery aneurysm and a subsequent arterioureteral fistula. An aortic stent graft was inserted to treat the arterioureteral fistula, but it subsequently became infected, resulting in the patient's death. This case underscores the importance of early diagnosis and treatment of arterioureteral fistula and the possibility of graft infection.
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Affiliation(s)
- Soomin Lee
- Department of Surgery, Daejeon Sun Hospital, Daejeon, Korea
| | - Hyejin Mo
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Mok Jung
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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2
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Surcel C, Mirvald C, Stoica R, Cerempei V, Heidegger I, Labanaris A, Tsaur I, Baston C, Sinescu I. Challenges in Diagnosis of Uretero–Arterial Fistulas after Complex Pelvic Oncological Procedures—Single Center Experience and Review of the Literature. Diagnostics (Basel) 2022; 12:1832. [PMID: 36010182 PMCID: PMC9406295 DOI: 10.3390/diagnostics12081832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Uretero–arterial fistula (UAF) represents a rare condition that manifests as massive or intermittent hematuria and requires collaboration between a urologist, vascular surgeon and interventional radiologist. In this article, we present our experience with UAF diagnosis, treatment pathways and the results of a nonsystematic review of the literature published in the last decade regarding modern diagnostic procedures. Material and method: We analyzed the clinical data of nine consecutive patients from our institution diagnosed with UAF in the interval of 2012–2022 who underwent open or endovascular surgical treatment. We reviewed patient characteristics, diagnoses and treatment pathways. The literature search resulted in 14 case series, published from 2012 to 2022, describing a total of 670 cases of UAF. Results: The mean age of patients in our cohort was 65.3 years (IQR: 51–79). UAFs were more common in women (77.7%). All patients presented a history of surgical intervention and ir-radiation for pelvic malignancy with permanent ureteric stenting. Overall, 88.8% of patients had urinary diversion, either via ileal conduit or cutaneous ureterostomy. The most common clinical manifestation of UAF was gross hematuria with or without clots accompanied by flank pain due to stent obstruction, while three patients presented with hypovolemic shock. Angiography represents the best option for diagnosis, followed by angioCT, with a sensitivity of 59.83% and 47.01%, respectively. There is no definitive imaging modality associated with high accuracy in detecting UAF and negative findings do not exclude the disease. In emergency cases with massive bleeding, surgical exploration remains the most appropriate management option for both diagnosis and treatment. Endovascular stent graft placement is preferred over open surgery in stable hemodynamic patients. Conclusions: Uretero–arterial fistulas represent a life-threatening complication and must be treated with great awareness. Angiography represents the best modality for diagnosis, followed by computed tomography. However, there is no definitive imaging modality and, in some cases, open approach remains the only option for diagnosis and treatment.
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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Brouwers JJWM, Baetens TR, van Schaik J. Minimally invasive treatment of vascular complications after neoaortoiliac system reconstruction using autologous vein grafts. J Vasc Surg Cases Innov Tech 2018; 4:283-286. [PMID: 30547147 PMCID: PMC6282657 DOI: 10.1016/j.jvscit.2018.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022]
Abstract
Treatment of complications after neoaortoiliac system vein reconstruction is a complex clinical problem with poor results. Endovascular treatment might offer an acceptable outcome in selected cases. We report two rare complications after neoaortoiliac system vein reconstruction for an infected aortic graft. These complications were treated with minimally invasive endovascular techniques. A 54-year-old man presented with an arterioureteral fistula located between the right ureter and the right branch of the venous reconstruction. The second case describes a 71-year-old man who developed a large dilation proximally in the venous reconstruction.
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Affiliation(s)
- Jeroen J W M Brouwers
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Tarik R Baetens
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan van Schaik
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands
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5
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Heers H, Netsch C, Wilhelm K, Secker A, Kurtz F, Spachmann P, Viniol S, Hofmann R, Hegele A. Diagnosis, Treatment, and Outcome of Arterioureteral Fistula: The Urologist's Perspective. J Endourol 2018; 32:245-251. [DOI: 10.1089/end.2017.0819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hendrik Heers
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
| | | | - Konrad Wilhelm
- Department of Urology, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Armin Secker
- Department of Urology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Florian Kurtz
- Department of Urology, Technische Universität München, Munich, Germany
| | - Philipp Spachmann
- Department of Urology, Krankenhaus St. Josef, University of Regensburg, Regensburg, Germany
| | - Simon Viniol
- Department of Diagnostic and Interventional Radiology, Philipps-Universität Marburg, Marburg, Germany
| | - Rainer Hofmann
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
| | - Axel Hegele
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
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6
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Abstract
Formation of an artery-to-ureter fistula (AUF) is a rare event caused by pelvic surgery or ureteral instrumentation. This presentation details the unique occurrence and treatment of simultaneous bilateral iliac artery-to-ureter fistulae. A 55-year-old man developed significant arterial hemorrhage during ureteral stent removal initially from the right and, subsequently, from the left side. Following expedient ureteral balloon tamponade, endovascular management via femoral approach with vein-covered stents was successful for each fistula without adverse long-term effects. Endoluminal therapy using autologous tissue-covered stents represents a simple, yet durable, treatment option in these challenging cases.
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Affiliation(s)
- Matthew R Uzieblo
- Department of Vascular Surgery, Washington University, St. Louis, MO 63110, USA.
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8
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Mujo T, Priddy E, Harris JJ, Poulos E, Samman M. Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula. Case Rep Radiol 2016; 2016:8682040. [PMID: 27293944 DOI: 10.1155/2016/8682040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/26/2016] [Indexed: 12/03/2022] Open
Abstract
Active extravasation via an arterioureteral fistula (AUF) is a rare and life-threatening emergency that requires efficient algorithms to save a patient's life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.
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9
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Copelan A, Chehab M, Cash C, Korman H, Dixit P. Endovascular management of ureteroarterial fistula: a rare potentially life threatening cause of hematuria. J Radiol Case Rep 2014; 8:37-45. [PMID: 25426238 DOI: 10.3941/jrcr.v8i7.1879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Ureteroarterial fistula is a rare, potentially life-threatening cause of hematuria characterized by an abnormal channel between a ureter and artery. The rarity of this condition, complexity of predisposing risk factors and intermittence of symptoms may delay or obscure its diagnosis. With a high index of suspicion and careful angiographic evaluation, embarking on this condition is not only possible but sets the stage for curative intervention. We report a case of a ureteroarterial fistula presenting with intermittent hematuria, successfully diagnosed at angiography and managed with endovascular stent graft placement.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Monzer Chehab
- Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Charles Cash
- Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Howard Korman
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, USA
| | - Purushottam Dixit
- Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, USA
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10
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ESCOBAR P, HOWARD J, KELLY J, ROLAND P, GRENDYS E, DOSORETZ D, ORR J. Ureteroarterial fistulas after radical pelvic surgery: pathogenesis, diagnosis, and therapeutic modalities. Int J Gynecol Cancer 2008; 18:862-7. [DOI: 10.1111/j.1525-1438.2007.01079.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 01/24/2008] [Indexed: 11/09/2022]
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12
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Muraoka N, Sakai T, Kimura H, Kosaka N, Itoh H, Tanase K, Yokoyama O. Endovascular Treatment for an Iliac Artery–Ureteral Fistula with a Covered Stent. J Vasc Interv Radiol 2006; 17:1681-5. [PMID: 17057011 DOI: 10.1097/01.rvi.0000236713.46897.05] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Iliac artery-ureteral fistula (IAUF) is a rare entity that has a potential risk of life-threatening hemorrhage. It is difficult to diagnose and treat appropriately. Conventional treatment for the disease consists of surgical ligation and vascular reconstruction or coil embolization. Surgical treatment is usually difficult for patients with several risk factors. In recent years, endovascular stent-graft treatment for iliac artery pseudoaneurysm has been reported. The present report describes two cases in which endovascular covered stent-graft treatment was successfully applied to treat IAUF, with good clinical outcomes.
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Affiliation(s)
- Noriaki Muraoka
- Departments of Radiology, University of Fukui, 23 Matsuoka-shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
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13
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Abstract
Ureteroarterial fistula is a rare but life-threatening cause of hematuria. The predisposing factors of a ureteroarterial fistula includes pelvic exenteration, radiation therapy, infection, primary vascular disease, vascular reconstructive surgery, and indwelling ureteral catheters or stents. We report a case of ureteroarterial fistula between the right ureter and a pseudoaneurysm originating from the right proximal external iliac artery in a female patient presenting with intermittent massive hematuria. She had previously undergone an operation for cervical cancer, radiation therapy, and ureteral stent placement. She was treated successfully by percutaneous endovascular stent graft placement to exclude the pseudoaneurysm. Percutaneous stent graft placement appears to be an effective and safe therapeutic alternative in the treatment of ureteroarterial fistula.
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Affiliation(s)
- Jui-Hsun Fu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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14
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Tuite DJ, Ryan JM, Johnston C, Brophy DP, McEniff N. Ureteroiliac fistula: a late sequela of radiotherapy and long-term ureteric stent placement. Clin Radiol 2006; 61:531-4. [PMID: 16713425 DOI: 10.1016/j.crad.2006.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2005] [Revised: 01/23/2006] [Accepted: 02/03/2006] [Indexed: 11/21/2022]
Affiliation(s)
- D J Tuite
- Department of Interventional Radiology, St James's Hospital, Dublin, Ireland.
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15
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Meester DJ, van Muiswinkel KW, Ameye F, Fransen H, Stockx L, Merckx L, Nevelsteen A. Endovascular Treatment of a Ureteroiliac Fistula Associated with Ureteral Double J-Stenting and an Aortic-Bifemoral Stent Graft for an Inflammatory Abdominal Aortic Aneurysm. Ann Vasc Surg 2006; 20:408-10. [PMID: 16779523 DOI: 10.1007/s10016-006-9048-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 08/23/2005] [Accepted: 02/27/2006] [Indexed: 10/24/2022]
Abstract
We report an unusual case of a ureteroiliac fistula due to prolonged ureteral stenting for hydronephrosis combined with an aortic-bifemoral stent graft in an inflammatory abdominal aortic aneurysm (AAA), treated with an endovascular stent graft. In a 77-year-old man ureteral J-stents were placed for bilateral hydronephrosis due to retroperitoneal fibrosis caused by an inflammatory AAA. The aneurysm was treated with an endovascular aortic-bifemoral stent graft. Three months later, the patient suffered from severe hypovolemic shock. Emergency angiography showed a fistula between the right ureter and the right common iliac artery just distal to the right leg of the stent graft. The ureteroiliac fistula was treated with a wall graft (10F). The patient recovered well and remained asymptomatic. Ureteroiliac fistula remains a rare complication of ureteral stenting. Several risk factors have been described before. This case emphazes the increased risk of an arterial-ureteral fistula due to an indwelling ureteral stent and an inflammatory AAA, especially in combination with an additional stent graft for this inflammatory AAA.
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Affiliation(s)
- Daan J Meester
- Department of Vascular Surgery, St. Lucas Hospital, Ghent, Belgium
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16
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Abstract
Iliac-ureteral fistulas (IUF) are a rare but potential life threatening event and an important cause of gross hematuria. We report on three cases of IUF. In all cases, prior chronic ureteral stenting, extended pelvic surgery or pelvic irradiation had been performed. Diagnosis was confirmed with angiography in one case, in the others a CT scan revealed the IUF. Treatment included surgical exploration with local reconstruction, extra-anatomical bypass and nephrectomy with arterial patch repair. The increasing incidence of IUF is a consequence of an increasing number of advanced and extended pelvic operations, radiation therapy and long-term ureteral stenting. Diagnosis should be made by provocative angiography or CT. Treatment options vary depending on the site and morphology of the local situation, but morbidity and mortality is still high due to delayed adequate diagnosis and treatment. A conclusive algorithm should be followed for the successful management of IUF.
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17
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Madoff DC, Gupta S, Toombs BD, Skolkin MD, Charnsangavej C, Morello FA, Ahrar K, Hicks ME. Arterioureteral Fistulas: A Clinical, Diagnostic, and Therapeutic Dilemma. AJR Am J Roentgenol 2004; 182:1241-50. [PMID: 15100126 DOI: 10.2214/ajr.182.5.1821241] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- David C Madoff
- Division of Diagnostic Imaging, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd., Unit 325, Houston, TX 77030, USA
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18
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Kwolek CJ, Matthews MR, Hartford JM, Minion DJ, Schwarcz TH, Quick R, Endean E. Endovascular Repair of External Iliac Artery Occlusion After Hip Prosthesis Migration. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0668:eroeia>2.0.co;2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Kwolek CJ, Matthews MR, Hartford JM, Minion DJ, Schwarcz TH, Quick R, Endean E. Endovascular repair of external iliac artery occlusion after hip prosthesis migration. J Endovasc Ther 2003; 10:668-71. [PMID: 12932185 DOI: 10.1177/152660280301000339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report emergent endovascular intervention to restore lower extremity arterial patency after migration of a hip prosthesis caused thrombosis of the external iliac artery (EIA). CASE REPORT Nine months following left hip revision arthroplasty, a 66-year-old woman presented to the Emergency Department with the complaints of an acutely painful left lower extremity for over 6 hours. Imaging showed the metallic acetabular portion of the hip prosthesis in the iliac fossa, with severe external compression of the EIA. After thrombolysis to remove clot from the EIA, an 8x60-mm self-expanding Smart stent was deployed in the left EIA from a contralateral access. The procedure was successful, and the patient was discharged. An infected wound from a compartment fasciotomy delayed revision of the hip prosthesis. Nine weeks after stenting, the patient returned with a cold, pulseless left limb; a femorofemoral bypass was constructed to restore perfusion. CONCLUSIONS While stent placement restored flow for 9 weeks after the initial ischemic event, the recurrent thrombosis could have been prevented by earlier revision of the migrated prosthesis.
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Affiliation(s)
- Christopher J Kwolek
- Department of Surgery, Vascular Section, University of Kentucky, Lexington, Kentucky, USA.
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