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.
Purpose: To describe the technique, efficacy, and safety of Endovenous Laser Ablation (EVLA) of incompetent perforator veins (IPV) using a bare tip fiber 1470nm laser alone or in combination with microplebectomy or sclerotherapy in the management of chronic venous insufficiency (CVI) with a competent saphenous system or prior saphenous interruption. Materials and Methods: 171 IPV were ablated in 101 limbs in 87 patients. Outcomes included sonographic occlusion of IPV, subjective changes to patient symptomatology, procedure related side effects (pain, hyperpigmentation) and complications (burns, major bleeds, infections, deep vein thrombosis or paresthesias). Correlation of IPV ablation failure with clinical, perforator and treatment characteritics was assessed using univariate (ANOVA) analysis. Results: 123 IPV were seen in the setting of prior saphenous interruption (76 radiofrequency ablation, 38 surgical stripping, 10 EVLA, 3 sclerotherapy). 48 were seen in the setting of a competent saphenous system. 91 IPV ablations were combined with microphlebectomy, 25 with sclerotherapy and 55 IPV were ablated alone. At 1 and 3 months follow up, 92 and 98% of ablated IPV were sonographically occluded. 10 IPV failed ablation with statistically significant correlation with higher CEAP score (p¼.002) and history of prior GSV interruption (p¼.042). Clinically, 82% and 96% of patients noted complete resolution of insufficiency symptoms at 1 and 3 months respectively. Complications included 5 patients with new onset paresthesias and one nonocclusive DVT. No skin burns, major bleeds or infections or were encountered. Conclusion: EVLA of IPV is effective at achieving IPV closure at 3 months can can be safely perfomed alone or in combination with microphlebectomy or sclerotherapy.
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