Autologous vein–covered stent for the endovascular management of an iliac artery–ureteral fistula: Case report and review of the literature

Kerns, David B.; Darcy, Michael D.; Baumann, Dirk S.; Allen, Bradley S.

doi:10.1016/s0741-5214(96)70084-8

Cited by 99 publications

(83 citation statements)

References 41 publications

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“…La performance de cet examen est améliorée par une manoeuvre de provocation du cathétérisme urétéral, le cas échéant. Sa sensibilité est nettement améliorée et peut ainsi atteindre 100 % 19,20 . Effectuée par un expert, l'artériographie permet en plus un geste endovasculaire d'hémostase 19 .…”

Section: Discussionunclassified

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Fistule artério-urétérale après une pelvectomie antérieure : Complication rare et grave

abidine

Hmida

Slama

et al. 2012

CUAJ

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RésuméLa fistule artério-urétérale (FAU), qui survient immédiatement après une cystectomie, est une complication exceptionnelle et grave. De nos jours, seulement quelques cas sporadiques ont été signalés dans la littérature. Elle se manifeste presque exclusivement par une hématurie brutale, massive et intermittente pouvant être à l'origine d'une instabilité hémodynamique menaçant le pronostic vital du patient à court terme. Son diagnostic doit être fait sans retard. Les explorations radiologiques restent peu spécifiques et peu sensibles et se basent essentiellement sur l'artériographie. Le traitement est non codifié selon l'état général du patient et surtout de la nature de la fistule. Nous décrivons un cas de FAU faisant suite à une pelvectomie antérieure et nous discuterons à l'aide d'une revue de la littérature les aspects diagnostiques, thérapeutiques et pronostiques de cette complication. IntroductionLa fistule artério-urétérale (FAU) est une complication très rarement décrite dans les suites immédiates d'une pelvectomie antérieure 1,2 . Il s'agit d'une complication grave pouvant mettre en jeu à court terme le pronostic vital du patient par le saignement important qu'elle va engendrer 3,4 . Son diagnostic est souvent difficile, et parfois déroutant et tardif. Il doit être établi sans retard sur des arguments cliniques et radiologiques. L'hématurie massive et intermittente reste le maître symptôme. Les explorations radiologiques sont peu spécifiques et peu sensibles; elles se basent essentiellement sur les données de l'artériographie. Le traitement est non codifié selon l'état général du patient et surtout la nature de la fistule.Nous signalons un nouveau cas de FAU survenue immé-diatement après une pelvectomie antérieure avec dérivation urinaire externe de type Bricker pour traiter une tumeur vésicale infiltrante. Nous discuterons à l'aide d'une revue de la littérature les aspects diagnostiques, thérapeutiques et pronostiques de cette complication. ObservationMadame Z. K., 60 ans, obèse (indice de masse corporelle de 35) et ne présentant pas d'antécédents pathologiques notables, notamment vasculaires, a été hospitalisée pour prise en charge d'une tumeur vésicale infiltrante. Une TDM abdominopelvienne préopératoire avait permis de conclure à la présence d'une tumeur vésicale T3N0M0. La patiente a subi une pelvectomie antérieure avec curage ganglionnaire ilio-obturateur bilatéral et une urétrectomie totale. Une dérivation urinaire externe trans-iléale de type Bricker a été effectuée. Le geste opératoire s'est déroulé sans incident ni complication peropératoire, notamment au moment du curage ganglionnaire, de la dissection des deux uretères et de l'anastomose urétéro-iléale. Les deux uretères étaient drainés par deux sondes urétérales.Les suites postopératoires immédiates étaient marquées au deuxième jour par un état septique sévère; les hémocul-tures ont permis d'isoler un type multirésistant d'Escherichia coli. La patiente a été mise sous double antibiothérapie bien adaptée. Au 10 e jour après l'opération et...

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Section: Discussionunclassified

“…Le traitement endovasculaire (embolisation, endoprothèse) a connu récemment un essor important et il est actuellement de plus en plus utilisé 16,20 . Toutefois, l'évolution à long terme est mal connue et expose à un risque accru de thrombose, de récidive et surtout d'infection 3,6 .…”

Section: Discussionunclassified

Fistule artério-urétérale après une pelvectomie antérieure : Complication rare et grave

abidine

Hmida

Slama

et al. 2012

CUAJ

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“…Ureteral ischemia and subsequent necrosis promote the formation of these fistulae [3]. A likely scenario is found in those patients with indwelling ureteral stents who had received radiation therapy; the constant pulsation of the iliac artery is transmitted to an already compromised ureter containing a stiff intraluminal foreign body, resulting in pressure necrosis, most likely where the ureter crosses the iliac artery [4À7].…”

Section: Discussionmentioning

confidence: 99%

“…Such ''chronic'' UAFs, which form the subject of the present paper, are a rare entity, often difficult to identify, and associated with a high mortality rate. It is important to remark that this fact has been attributed to a delay in diagnosis and treatment [3].…”

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confidence: 99%

The Arterial Folding Point During Flexion of the Hip Joint

Park

Won

Kim

et al. 2005

Cardiovasc Intervent Radiol

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Background: Ureteroarterial fistulae (UAFs) are a rare entity, often difficult to identify, and associated with a high mortality rate. This fact has been attributed to a delay in diagnosis and treatment. Five conditions that can predispose to the development of this uncommon entity have been described: prior pelvic surgery, prolonged ureteral stenting, radiation therapy, previous vascular surgery and vascular pathology. Methods: We present 4 patients with UAFs and at least three of the above-mentioned conditions. Ureteral ischemia and subsequent necrosis promote the formation of these fistulae. The constant pulsation of the iliac artery is transmitted to an already compromised ureter containing a stiff intraluminal foreign body, resulting in pressure necrosis, most likely where the ureter crosses the iliac artery. Results and Conclusion: Cases were managed percutaneously with a combination of the deployment of a covered prosthesis and, when needed, with mechanical occlusion of the ureter. Hematuria stopped in all the patients with no evidence of immediate rebleeding. One patient presented a new episode of vaginal bleeding 13 months after endograft placement and ureteral embolization. Arteriography showed the presence of a hypogastric artery pseudoaneurysm that was occluded using coils. No new bleeding has occurred in this patient 12 months after the second embolization. At present all 4 patients are alive with follow-up periods of 5, 9, 11 and 25 months since the first procedure.

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“…These are uncommon but serious; the mortality rate ranges from 7% to 23%; 4,5 when the diagnosis is not made before surgery, the mortality could reach 58%. 6 Rapid diagnosis followed by appropriate treatment significantly reduces the mortality.…”

Section: Uretero Arterial Fistulamentioning

confidence: 99%

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

Dormeus

Hernandez

Nicolazzi

et al. 2013

CUAJ

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E146Ureteroiliac fistula secondary to radiotherapy in a patient with single renal metastasis of colon adenocarcinoma Cite as: Can Urol Assoc J 2013;7:E146-E149. http://dx.doi.org/10.5489/cuaj.259 AbstractWe report the case of a 61-year-old man diagnosed in 2001 with rectal cancer (stage T3N1M0). The patient was treated with surgery, adjuvant chemotherapy and radiotherapy. In 2009, he was admitted to the urology department with a complaint of right hemiabdominal pain. The anatomopathological investigation reported renal metastasis of colon adenocarcinoma. After surgery, he received adjuvant chemotherapy. No tumour recurrence or metastasis was reported at the 22-month follow-up. IntroductionThe kidney is the fifth most frequent site of metastasis in tumours. However, secondary neoplasm only accounts for 3% of renal malignant disease. Ureteroiliac fistulas are infrequent but serious conditions, with a mortality rate that ranges from 7% to 23%. We report these two rare conditions in a single patient. Case reportA 61-year-old man was diagnosed in 2001 with moderately differentiated rectal cancer (stage T3N1M0). The patient was treated by surgery, adjuvant chemotherapy and radiotherapy. He was under medical control until September 2003, when the disease progressed to the level of colorectal anastomosis. This time, the right ureter was also involved with disease, the tumour was based on the right iliac vessels and infiltrated small intestine. Therapeutic approach consisted in surgery and radiotherapy in the tumoural area, followed by adjuvant chemotherapy.In 2009, he was referred to the department of urology with complaints of right hemiabdominal pain for 2 days. He also presented with asthenia, dyspnea with minimal efforts and vomiting on two occasions before his admission to hospital.Physical examination was only positive for right hemiabdominal tenderness and decreased bowel sounds. He was afebrile. Blood test showed anemia (hemoglobine levels: 7.4 g/dL) and hyperbilirrubinemia with cholestatic pattern. Creatinine levels were 1.7 mg/dL. Abdominal x-ray did not revealed any abnormalities. One 20-cm heterogeneous lesion in the right hemiabdomen, a grade IV/IV ureteral hydronephrosis in the right urinary tract and grade II/IV in the left side were seen on the abdominal ultrasound. These findings were correlated with the impaired renal function.A computed tomography (CT) scan showed a small right pleural effusion, which confirmed bilateral ureteral hydronephrosis with a kidney size of 20 × 17 × 23 cm. The radiologist report concluded a right ureteral hydronephrosis grade IV/IV, with large renal and urinary tract dilatation and compressive effect on the liver, the small intestine and the colon (Fig. 1, Fig. 2).We catheterized the left urinary tract which resolved the hydronephrosis. After performing this procedure on the right side, we found blood circulating again. This sign was also observed when we tried to place a nephrostomy in the right kidney.A renal arteriography revealed an irregular lesion in the middle zone of...

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Autologous vein–covered stent for the endovascular management of an iliac artery–ureteral fistula: Case report and review of the literature

Cited by 99 publications

References 41 publications

Fistule artério-urétérale après une pelvectomie antérieure : Complication rare et grave

Fistule artério-urétérale après une pelvectomie antérieure : Complication rare et grave

The Arterial Folding Point During Flexion of the Hip Joint

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

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