Uretero-iliac artery aneurysm fistula: A rare but fatal cause of haematuria

Abstract

Visible haematuria from an uretero-iliac artery aneurysm fistula (UIAF) offers a diagnostic challenge and early accurate diagnosis can have a significant impact on prognosis. We report a 90 year old gentleman who presented with visible haematuria and clot retention. He required catheterisation, bladder washout and a blood transfusion. Subsequent imaging revealed an abdominal aortic aneurysm and bilateral iliac artery aneurysms with left sided hydronephrosis and hydroureter. There was no radiological evidence of a fistula between the left ureter and iliac aneurysm. Due to associated co-morbidity surgical intervention was not deemed suitable. Although his haematuria initially settled he developed catastrophic haematuria and died. Post-mortem confirmed UIAF causing fatal haemorrhage. In this report we discuss the diagnostic challenges and management options for this condition.

Ureteroarterial Fistula: A Diagnosis Which Is Not Always Black and White

“…Prior to advancements in endovascular techniques, open surgical repair was the predominant manner in which UIAF was treated and was considered the gold standard [ 8 , 9 ]. However, this was often challenging as these patients have a complex history of genitourinary surgery, radiation treatment, and vascular pathology [ 10 ].…”

A Rare Cause of Anuria: A Case of Inflammatory Iliac Aneurysm

“…Urological symptoms occur when the bladder and ureter are affected and can be in the form of urinary retention or microscopic hematuria. Macroscopic hematuria usually suggests an ureteroiliac aneurysmal fistula and is fatal (6). Most of these patients have an increased erythrocyte sedimentation rate or laboratory findings of inflammation.…”

Endovascular Repair of an Iliac Ureteroarterial Fistula with Late Stent Thrombosis and Migration into the Bladder

“…Recently, surgical takedown of these fistulas has been replaced as the treatment of choice by minimally invasive endovascular stent-grafting due to high open operative morbidity (1,2). Several recent case reports and small case series describe endovascular stent-grafting as a viable option to avoid an open procedure in an often reoperative, scarred, or irradiated field (1,3,4). …”

“…Repair with endovascular stent-grafting has been described, but complications of these procedures not been well documented (4–6). We describe a case of endovascular repair of UAF and examine late complications associated with the procedure.…”