Ureteroarterial Fistula

Abstract

Ureteral-iliac artery fistula (UIAF) is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.

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.…”

“…UAF is seldom expected, but having a clinical suspicion is paramount for guiding decision-making. There have been some case reports, but data is scarce regarding etiology and management [1][2][3][4]. Thus, we offer our personal experience to help validate current diagnostic and treatment options.…”

Ureteroiliac fistula secondary to radiotherapy in a patient with single renal metastasis of colon adenocarcinoma

“…Several conditions can explain the formation of fistulas between an iliac artery and the ureter: underlying vascular pathology, previous surgery (genitourinary, pelvic and vascular operations), previous radiotherapy (although only in combination with surgery) and endoureteral procedures (e.g., prolonged use of ureteral stents or catheters, especially rigid ones, ureterolithotomy complicated with a urinary leakage). [7][8][9][10][11] Like our patient, most people developing these fistulas have a history of pelvic malignancy. Infection and pregnancy are also risk factors.…”

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

“…Previous studies have demonstrated a high mortality rate (64%) in patients who underwent exploratory laparotomy without adequate preoperative diagnosis. This was reduced to 0% in patients where the diagnosis was considered prior elective surgery (5). …”