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

Abstract

Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment.Methods This retrospective case series evaluates a single center experience of percutaneous stent graft angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. Results We identified 17 UAF in 16 consecutive patients (12 male, 4 female, mean age 69.8 ±11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 presented with flank pain, in 7 of 17 cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, pelvic exstirpatory surgery in 13 cases. In 6 cases stent grafts were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). Stent graft placement without previous coil embolization was performed in 10 fistulas. In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1 – 3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases. Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment.Conclusion Endovascular therapy proves to be a safe and efficient method in UAF treatment.Evidence-based medicineLevel 4, case series.