Uretero‐arterial fistula treated with endovascular stent graft following multiple interventions

Kaneko, Tomoyuki; Sakamoto, Akihiko; Yamada, Yukio; Yamamoto, Masayoshi; Kondo, Hiroshi; Nakagawa, Tohru

doi:10.1002/iju5.12216

Cited by 3 publications

(1 citation statement)

References 7 publications

(23 reference statements)

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“…Первичное диагностическое обследование включает ангиографию, компьютерную томографию, уретерографию. Симптомы патологии неспецифические и на момент обследования могут отсутствовать [1][2][3][4][5]. Есть данные о проведении провокационных тестов при цистоскопии, инициирующих гематурию из фистулы, однако метод может вызвать неконтролируемое кровотечение и геморрагический шок [3][4][5][6][7].…”

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Clinical case of successful endovascular correction of an arterio-ureteral fistula

Chernyavsky¹,

Mosoyan²,

Vanyurkin³

et al. 2021

PKiK

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Arterio-ureteral fistulas are a pathological condition characterised by the appearance of a defect between the blood vessels and adjacent distal segments of the ureter. Arterio-ureteral fistulas are relatively rare and potentially life-threatening, since they are associated with a high risk of developing haemorrhagic shock against the background of recurrent massive haematuria. This study describes the successful endovascular treatment of arterio-ureteral fistulas in a 51-year-old female patient. Evisceration of the pelvic organs was performed, followed by uretero-cutaneostomy and colostomy. Ureteral stents were installed to improve the outflow of urine and prevent ureteral stenosis. After stent removal, episodes of recurrent profuse bleeding from uretero-cutaneostomy occurred. On admission, multi-spiral computed tomography with angiography of the iliac arteries was performed. Extravasation of the contrast agent was not detected; however, external compression of the left common iliac artery by the left ureter was identified. After further examination, a balloon-expandable stent-graft was implanted into the left common iliac artery. The postoperative period thereafter was uneventful. This clinical case demonstrates the highly efficient endovascular treatment of the presented pathology and exemplifies the need for an integrated and multidisciplinary approach in the diagnosis and treatment of arterio-ureteral fistulas. Minimally invasive techniques can reduce surgical trauma and quickly isolate pathological blood discharge from the artery into the ureter. The advantages and disadvantages of endovascular technologies in the treatment of the presented pathology are also discussed.Received 16 February 2021. Revised 11 March 2021. Accepted 12 March 2021.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflicts of interests.Contribution of the authors Drafting the article: A.G. Vanyurkin, A.N. Kazantsev Critical revision of the article: M.A. Chernyavsky, N.V. Susanin, M.S. Mosoyan Surgical treatment: M.A. Chernyavsky, A.G. Vanyurkin, N.V. Susanin Final approval of the version to be published: M.A. Chernyavsky, M.S. Mosoyan, A.G. Vanyurkin, N.V. Susanin, A.N. Kazantsev

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Clinical case of successful endovascular correction of an arterio-ureteral fistula

Chernyavsky¹,

Mosoyan²,

Vanyurkin³

et al. 2021

PKiK

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A systematic review of management of ureteroarterial fistula

Ebata¹,

Morisaki²,

Matsubara³

et al. 2022

Journal of Vascular Surgery

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Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature

et al. 2021

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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 (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management. Results We identified 17 UAF in 16 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 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). 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 (82.4%). 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. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%). Conclusion Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary. Evidence-based medicine Level 4, case series.

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Uretero‐arterial fistula treated with endovascular stent graft following multiple interventions

Cited by 3 publications

References 7 publications

Clinical case of successful endovascular correction of an arterio-ureteral fistula

Clinical case of successful endovascular correction of an arterio-ureteral fistula

A systematic review of management of ureteroarterial fistula

Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature

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