Diagnosis, Treatment, and Outcome of Arterioureteral Fistula: The Urologist's Perspective

Abstract

AUF results in major hemorrhage and warrants time-efficient diagnosis and treatment. Awareness is key. When AUF is considered, interventional angiography should promptly be performed. Fistula detection can be improved by guidewire manipulation. Pre-interventional CT angiogram may be omitted due to low sensitivity. Endovascular repair with stenting and/or coiling is effective and safe.

Results of Endovascular Therapy of Ureteroarterial Fistulas: A Single Center Experience 

“…The need for blood transfusions and/or inotropic therapy is common. Flank pain and fever are further occurring as well (Heers et al, 2018).…”

“…Provocative angiography as an invasive imaging tool has been described as an effective procedure to demonstrate the In the therapeutic management, there has been a paradigm shift from a surgical approach, which was still the standard of care in 2004, toward interventional angiography (Bergqvist et al, 2001;Fox et al, 2011;Madoff et al, 2004). Patients typically carry a high risk for complications due to previous extensive surgery and radiation therapy which lead to adhesions, brosis, and frail tissue (Heers et al, 2018). In patients with UAF to the IIA only, arterial coil embolization can be considered.…”

“…In view of the low incidence of this disease and continuously evolving diagnostic and therapeutic tools, it seems di cult to establish evidence-based recommendations for these patients. Nevertheless, both urologists and interventional radiologists seem to be well aware of the special features of this rare disease (Heers et al, 2018).…”

Life-threatening arterioureteral fistula treatment by endovascular complete anatomic iliac artery bifurcation reconstruction

“…Extensive pelvic surgery, radiation therapy, and resulting ureteral obstruction in combination with indwelling ureteral stents are common causes of AUF. 1,2 Demographics in industrial nations, improved long-term survival after pelvic irradiation, and increasing numbers of patients with ureteral stenting result in rising numbers of patients with AUF. Typical localization is the pelvic brim, where ureters are crossing the CIA.…”

“…Endovascular treatment by percutaneous deployment of stent grafts for false aneurysm coverage has been established as the treatment of choice. 1,2 However, for closure of the underlying pseudoaneurysm, the internal iliac artery (IIA) is regularly sacrificed. This technical report illustrates a minimally invasive concept for IIA preservation, avoiding consecutive sequelae (eg, impaired pelvic perfusion) resulting in buttock claudication or compromised wound healing.…”