Uretero-Iliac Artery Fistula: A Diagnostic and Therapeutic Challenge

Abstract

Uretero-Iliac artery fistulas (UAFs) are very uncommon in urological practice. The rarity of this clinical entity may lead to a delayed or missed diagnosis which can result in life-threatening consequences. We present a case of a right ureteric and right external iliac artery fistula, its presentation, diagnosis, and management along with the review of the literature.

Uretero-Arterial Fistula: A Modern Case of an Orphan Disease

“…arterial aneurysms, atherosclerosis, or arterial-venous malformations). Secondary UAF develops with external risk factors such as a history of pelvic surgery, radiation therapy, or indwelling ureteral stents [1,7,8]. The patient in our case had 4 of these conditions.…”

Case ‒ Uretero-internal iliac artery fistula presenting with multiple negative angiographic studies

“…1 UAF should be included in the differential diagnosis of patients with unexplained visible hematuria presenting with a history of chronic ureteric stenting, pelvic radiotherapy, genitourinary or vascular surgery, all of which have been demonstrated as risk factors (Table 1) predisposing to UAF formation. 1,2 In some cases of UAF, the initial bleed has been during stent change. 1 In most cases, the only symptom is painless hematuria.…”

“…1,2 Cystoscopy and retrograde pyelography were historically believed to have the greatest sensitivity, between 45% and 60%, however with significant bleeding, these may not be possible and therefore sensitivity is believed to be decreased. 2,3 Ureteroscopy is relatively contraindicated due to the risk of disrupting an obstructing clot or tearing the fistula, resulting in significant hemorrhage.…”

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

“…This increases the susceptibility of the aneurysm to necrosis and rupture (1). Additional contributory factors hastening the development of fistulae include pelvic radiation, direct trauma from pelvic surgery, ureteric instrumentation and ureteric stenting (2,3)…”

“…A multidisciplinary team approach involving urologists, vascular surgeons and radiologists is important in the treatment of uretero-iliac aneurysm fistula (3). Management involves concurrent repair of arterial and ureteric aspects of the fistula.…”