Uretero-iliac artery fistula: a challenge diagnosis for a life-threatening condition: monocentric experience and review of the literature

Leone, Luca; Scarcella, Simone; Dell’Atti, Lucio; Tiroli, Marco; Sternardi, Francesca; Galosi, Andrea Benedetto

doi:10.1007/s11255-019-02097-2

Cited by 21 publications

(18 citation statements)

References 17 publications

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“…3 In fact, uretero-vascular malformation, including uretero-iliac artery fistula and AVM, represent life-threatening conditions characterized by significant gross hematuria. 6 Although our patient had significant, gross, and chronic hematuria, early imaging studies did not reveal any evidence of AVM. Additionally, there were several ultrasonograms performed that never revealed calculi, ureteropelvic junction, or UVJ abnormalities.…”

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confidence: 50%

Chronic, Gross Hematuria Caused by Idiopathic Ureteric Stricture

Myette¹,

Acker²

2019

Pediatrics

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An otherwise healthy, 10-year-old boy presented with chronic, gross hematuria. This persisted daily for 5 years despite extensive multidisciplinary workup with renal biopsy and resulted in severe iron deficiency anemia. The extensive workup and requirement for routine follow-up, investigations, and procedures led to significant psychosocial distress for the patient. Initially, it was thought the patient had a nutcracker phenomenon, but on closer inspection of his ureters, an idiopathic, unilateral ureteric stricture was discovered and, after 8 weeks of stenting, resulted in complete resolution of the hematuria. Importantly, the patient's psychosocial distress resolved after resolution of the hematuria and with the closure that came with a diagnosis.

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Chronic, Gross Hematuria Caused by Idiopathic Ureteric Stricture

Myette¹,

Acker²

2019

Pediatrics

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“…Ureteral stent-related UAF are reported in a small number of cases; the causative factor has been attributed to prolonged stent placement varying from 5 months to 15 years before the onset of hematuria [ 2 ]. The etiology of UAF is not well understood; a possible mechanism is related to the alteration in the ureteral wall elasticity with eventual pressure necrosis [ 3 ].…”

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confidence: 99%

“…Since these bleedings occur intermittently, the diagnosis is very difficult; in fact, UAF can be life-threatening because of potential massive blood loss, and diagnosis can easily be delayed or even missed because the presence of hematuria could be ascribed to variety of other urologic diseases. The mortality associated with UAF ranges from 7 to 58%, and the clinical outcome is correlated with an early diagnosis [ 2 , 3 ]. UAF requires a rapid a multidisciplinary approach, including the expertise of the urologist, vascular surgeon, and interventional radiologist, to detect and treat this unusual disease [ 4 , 5 ].…”

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confidence: 99%

Asynchronous Bilateral Ureteric-Arterial Fistula: Diagnosis and Treatment

Pepe

D’Arrigo

Patanè

et al. 2021

Case Reports in Urology

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A 48-year-old woman submitted to anterior exenteration plus ileal-cutaneous conduit for metastatic cervical cancer during the change of the ureteral stent showed massive bleeding in the left ureter. A selective intra-arterial angiography showed a fistula between the ureter and the left common iliac artery that the interventional radiologist quickly repaired by inserting a vascular endoprosthesis. Six months later, gross hematuria secondary to right ureter-iliac fistula occurred again and a second endoprosthesis was inserted. Asynchronous bilateral ureteric stent-related vascular fistula is an uncommon scenario, but it should be suspected in the presence of hematuria following ureteral stent replacement.

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“…18–20 Chronic indwelling ureteral stents in patients with a history of pelvic malignancy can also precipitate the formation of UAFs. 18,21,22…”

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confidence: 99%

Endovascular and open surgical options in the treatment of uretero-arterial fistulas

et al. 2020

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Objective To report and analyze the indications and results of endovascular and open surgical treatment for uretero-arterial fistula. Methods We retrospectively reviewed the clinical data of 25 consecutive patients with uretero-arterial fistulas admitted to our hospital from 2011 to 2020. Endpoints were technical success, freedom from open conversion, stent-graft/graft-related complications, and 30-day and one-year mortality. Results The study included 25 patients (68% female, n = 17) with 27 uretero-arterial fistulas by bilateral pathologies in two patients. The mean age was 61 ± 11 years (range 35–80). The most common predisposing factors for uretero-arterial fistula were history of pelvic operations for malignancy in 21 patients (84%), radiotherapy in 21 patients (84%), previous pelvic vascular bypass in 2 patients (8%), and iliac aneurysms in 2 patients (8%). On average, the period between the primary pelvic surgery and the diagnosis of uretero-arterial fistulas was 46 months (range 7–255). Twenty patients (80%) underwent endovascular treatment of the uretero-arterial fistulas. The primary technical success of the endovascular treatment was 95%, and the freedom from open conversion was 40% at six months and 30% at one year. Thirteen uretero-arterial fistulas (48%) underwent delayed open conversion due to recurrent bleeding in six cases (46%), stent-graft infection in three cases (23%), or pelvic abscess in four cases (31%). Primary open surgery was applied for five (20%) patients. After a mean follow-up of 34 months, early (<30 days) mortality was 8% (2/25), one-year mortality 16% (4/25), and overall mortality was 24% (6/25). Conclusions Uretero-arterial fistula is a late complication of prior pelvic surgery, radiation, and indwelling ureteral stents. Endovascular treatment remains an effective and less invasive modality in controlling the related life-threatening arterial bleeding of the uretero-arterial fistula. Open surgical treatment is still required for patients with local sepsis, previously failed endovascular treatment or infected stent-grafts.

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Uretero-iliac artery fistula: a challenge diagnosis for a life-threatening condition: monocentric experience and review of the literature

Cited by 21 publications

References 17 publications

Chronic, Gross Hematuria Caused by Idiopathic Ureteric Stricture

Chronic, Gross Hematuria Caused by Idiopathic Ureteric Stricture

Asynchronous Bilateral Ureteric-Arterial Fistula: Diagnosis and Treatment

Endovascular and open surgical options in the treatment of uretero-arterial fistulas

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