Die iliakoureterale Fistel und ihre Therapie

Abstract

Arterio-ureteral fistulas are rare. A life-threatening complication is severe hemorrhage. More than 50 per cent of the cases were reported during the last ten years. The predisposing causes mainly are operations of malignomas of the kidney and the efferent urinary tract as well as gynecological neoplasias with or without irradiation. Stenting of the ureter or reconstructive vascular surgery may also cause arterio-ureteral fistulas. Because of the intermittent symptomatology diagnosis may be very difficult. Therapy and prognosis for life as well as for organ failure depend on pretherapeutic examination. In former times surgical repair was the therapy of choice. With the introduction of interventional techniques morbidity and mortality decreased significantly. During the last five years three patients with iliac-ureteral fistulas were treated in our department. In two cases the fistulas was excluded by covered stent grafts, in one case coiling alone of the internal iliac artery was successful. Reviewing the literature and our experience with arterio-ureteral fistula angiography is recommended for diagnostics. Covered iliac stent grafts are the therapeutic option of choice. The leakage of the ureter needs not to be repaired mandatoryly.

Clinical case of successful endovascular correction of an arterio-ureteral fistula

“…Пульсирующий кровоток в артериях создает механическое трение, вызывая раздражение и структурное ослабление стенок с последующим прорывом крови в просвет мочеточника [2; 3; 6]. 85 % АМФ вторичные, возникающие после хирургических вмешательств по поводу рака органов брюшной полости и малого таза, а также из-за размещения артериальных трансплантатов вблизи от мочеточников, установки постоянных мочеточниковых стентов для отвода мочи [8][9][10][11]. Патогенез вторичных АМФ схож с первичными: пульсация артерии и ее непосредственная близость с мочеточником создают механическое трение и приводят к эрозии их стенок.…”