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Active extravasation via an arterioureteral fistula (AUF) is a rare and life-threatening emergency that requires efficient algorithms to save a patient's life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.

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Background: Few studies have assessed the relationship between serum alpha-fetoprotein (AFP) and yttrium-90 (Y-90) radioembolization response in hepatocellular carcinoma (HCC). The objective of the study was to evaluate whether peri-procedural serum AFP was correlated with Y-90 therapy response in HCC.Methods: Patients undergoing Y-90 radioembolization with glass microspheres (TheraSphere™) for HCC between 2006 and 2013 at a single center were evaluated. The relationship between AFP and 6month radiographic improvement (complete or partial response by modified RECIST criteria), overall (OS), and disease-specific survival (DSS) were analyzed.Results: Seventy-four patients underwent a total of 124 Y-90 infusions. Median age was 65 years, median AFP was 37 ng/mL (range: 2-112,593 ng/mL) and median model for end-stage liver disease score was 6.2 (range:1.8-11.2). Increased AFP was not associated with radiographic improvement (odds ratio (OR) = 0.99, 95% confidence interval (CI) = 0.75-1.30, p = 0.92). Median OS was 15.2 months and was increased in patients with low AFP compared to high AFP (30.8 months vs. 7.8 months, p < 0.001).On multivariable regression analysis, increased AFP was associated with worse OS (OR = 1.11, 95%

extravasation and hematoma were coded from the original trauma and dedicated pelvic CTs. Data was analyzed using a Categorical Principal Component Analysis (CatPCA) and Multinomial Logistic Analysis. Results: Two hundred and sixty-eight cases were included, with 20 undergoing embolization and 7 that had diagnostic angiography only. CatPCA identified 9 different possible dimensions (l > 1), of which 5 where significant (p ¼ 0.5) predicting embolization include age, injury severity scale, extraversion and pseudoaneurysm, injury to sacroiliac joints and pubic symphysis, and iliac fractures. Components with highest correlation to diagnostic angiography only include obturator ring, acetabular, and proximal femur fractures, hemarthrosis, pelvic organ and intramuscular hematoma. Conclusions: Exploratory analysis with CatPCA may be used to identify factors that predict the need for embolization in osseous pelvic trauma. Models may be formulated from the resulting analysis to provide a clinical score to aid in protocoled management of pelvic trauma.