Uretero-Arterial Fistula - Not So Rare?

Turo, Rafal; Hadome, Ewere; Somov, Pavlo; Hamid, Bushra; Gulur, Dev Mohan; Pettersson, B.; Awsare, Ninaad

doi:10.1159/000489419

Cited by 16 publications

(11 citation statements)

References 10 publications

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“…UAF is a rare complex problem involving multiple organ systems, usually occurring in patients with significant comorbid conditions due to malignancy, irradiation, previous surgical interventions and indwelling ureteral stents (Das et al 2016;Turo et al 2018). A previous report demonstrated that a pseudoaneurysm was detected in up to 38% of cases with UAF, and CT could show an enhancing mass near the crossing of the ureter (Van den Bergh et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

Horie

Fujiwara²,

Satoyoshi³

et al. 2019

CVIR Endovasc

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Background: Ureteroarterial fistula is a rare life-threatening complication of indwelling ureteral stents. The mechanism has not yet been fully evaluated using intravascular imaging. Case presentation: An-84-year-old female was referred to our unit because of large volume pulsatile bleeding from the left ureter during routine stent exchange in the urology department. The hematuria was initially managed by rapidly exchanging for a new stent; however, the patient went into hypovolemic shock due to acute blood loss. The patient underwent implantation of the bilateral ureteral stents due to urinary retention caused by retroperitoneal fibrosis 2 years ago. To prevent ureteral infection, occlusion of the stents and stone formation, the stents were exchanged every 6 months. Computed tomography revealed contact between the left ureter and the common iliac artery. Therefore, ureteroarterial fistula was suspected and endovascular therapy was performed. Although angiography did not show definite blood flow into the ureter, a soft guidewire was advanced from the subintima of the external iliac artery to the left ureter. The diagnosis of ureteroarterial fistula was confirmed. Intravascular ultrasound identified the stent in the ureter and its connection to the subintima of the external iliac artery. The ureter did not contact directly to the inner lumen of the iliac arteries according to the ultrasound findings; therefore, we considered that the risk of stent-graft infection might not be high. After coil embolization of the ipsilateral internal iliac artery, a covered stent was implanted in the external iliac artery to seal the subintimal entry. The patient had no further episodes of any gross hematuria on dual anti-platelet therapy, when the ureteral stent was exchanged three time during 1 year after the endovascular therapy. Conclusions: We demonstrated a case of ureteroarterial fistula, in which intravascular ultrasound allowed to visualize the communication between the ureter and the subintimal lumen in the external iliac artery.

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Section: Discussionmentioning

confidence: 99%

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

Horie

Fujiwara²,

Satoyoshi³

et al. 2019

CVIR Endovasc

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“…9 Although the actual underlying pathophysiology for fistula formation has not yet been fully understood, major surgical interventions in the pelvis with damage to the vasa vasorum on the ureter and artery as well as radiation appear to play an important role due to local damage and necrosis. 9 In addition, the constant pulsation of the artery seems to have an influence on the formation of a fistula between ureter – mostly with a double J catheter in it – and artery where the two organs are in contact. 9 While primary ureteroarterial fistulas are always caused by an abnormality of the arterial vessel (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…9 In addition, the constant pulsation of the artery seems to have an influence on the formation of a fistula between ureter – mostly with a double J catheter in it – and artery where the two organs are in contact. 9 While primary ureteroarterial fistulas are always caused by an abnormality of the arterial vessel (e.g. aneurysm or vascular surgery), secondary fistulas, which are much more common, develop mainly in connection with large gynaecological or urological cancer surgeries, insertion of ureteral stents and devascularisation of the ureter.…”

Section: Discussionmentioning

confidence: 99%

Lethal haemorrhage due to erosion of external iliac artery in a patient with ureterovaginal fistula following endometriosis surgery

Widschwendter

Janni

Benckendorff

et al. 2019

Journal of Endometriosis and Pelvic Pain Disorders

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We present a case report of a patient with laparoscopic surgery of a deep infiltrating endometriosis with a complicative course. In addition to a postoperatively diagnosed ureteral fistula with local inflammation, acute perforation and ultimately lethal bleeding from the adjacent external iliac artery occurred more than 3 weeks after surgery. To the best of our knowledge, a case with the same constellation has not yet been published. A literature review on the rare and comparable complication of a ureteroarterial fistula is discussed in connection with the case.

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“…Uretero-arterial fistula (UAF) is relatively rare with only 150–162 cases described in literature. The incidence of UAF is increasing secondary to improved pelvic cancer treatment and survival [ 1 – 3 ]. Reported UAFs predominantly communicate with the iliac arterial system.…”

Section: Introductionmentioning

confidence: 99%

Endovascular coil embolization of inferior mesenteric artery to ileal-conduit fistula: a case report

et al. 2022

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Background Uretero-arterial fistulas (UAFs) are uncommon and pose a diagnostic dilemma, making them life threatening if not recognized and treated expediently. UAFs to small arteries such as a branch of the inferior mesenteric artery (IMA) are very uncommon and present a further diagnostic and treatment challenge. There should be a high index of suspicion for UAFs when intervening on patients with history of treated pelvic cancers and long-standing ureteric stents experiencing hematuria not attributable to another cause. Case presentation We present a case of a fistula formed between a distal branch of the IMA—superior rectal artery—and an ileal-conduit in a patient with a long-standing reverse nephroureterostomy (Hobbs) catheter presenting with abdominal pain and hematuria through the conduit. During a tube exchange, contrast injection demonstrated a fistula with the superior rectal artery, multiple ileal intraluminal blood clots, and active extravasation. The patient became tachycardic and hypotensive, actively bleeding through the ileal-conduit, prompting a massive transfusion protocol. Successful endovascular coiling of the superior rectal artery was performed with resolution of active extravasation and stabilization of the patient. The patient recovered and was discharged in stable condition 10 days later. Conclusions Although UAFs are uncommon, our case demonstrated key predisposing risk factors to fistula development; pelvic cancer surgery, pelvic radiation, and a prolonged ureteric stent through the ileal-conduit. Typically, UAFs arise from communication with the iliac arterial system, however in this instance we have demonstrated that fistulization to other arterial vessels is also possible. Endovascular management has become the preferred method of therapy, typically involving the placement of covered stents when involving the iliac arterial system. In this instance stent grafting was not possible due to the small caliber vessel and therefore had to be embolized.

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Uretero-Arterial Fistula - Not So Rare?

Cited by 16 publications

References 10 publications

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

Lethal haemorrhage due to erosion of external iliac artery in a patient with ureterovaginal fistula following endometriosis surgery

Endovascular coil embolization of inferior mesenteric artery to ileal-conduit fistula: a case report

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