Endovascular management of ureteroarterial fistula

Abstract

Ureteroarterial fistulas, although rare, appear to be increasing in frequency. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide an attractive treatment alternative. We review the diagnosis and management of a ureteroarterial fistula and iliac pseudoaneurysm that presented with massive hematuria during ureteral stent removal. The patient was treated by means of the percutaneous embolization of the right hypogastric artery and placement of an expanded polytetrafluoroethylene stent-graft. Endovascular stent-graft placement may serve as a safe and practical alternative in the treatment of these patients, whose cases are challenging.

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

“…Le pronostic des FAU s'est nettement amélioré ces der- nières années grâce aux progrès des techniques diagnostiques et thérapeutiques 6,7,23 . En effet, la mortalité en lien avec les FAU est passée de 70 % dans les années 80 à moins de 30 % 8 .…”

Endovascular treatment of ureteroarterial fistulas with stent-grafts

“…[1][2][3][4][5][6][7][8][9] They have been reported to be associated with several conditions, including previous pelvic surgery, radiation therapy, indwelling ureteral stents, infection, primary vascular disease, and pregnancy. Among these etiologies, the fi rst three conditions appear to be the most important factors regarding the formation of such a fi stula.…”

“…8 Several methods have been reported for treating ureteroarterial fi stulas. Recently, reports of interventional radiology methods have increased, including embolizing the artery 6 and a combination of embolizing the artery and surgical bypass grafting, 1,2,4,8 endovascular repair by stent-grafts, 3,5,9 and embolizing the ureter with nephrostomy. 7 Reports of endovascular treatment for the fi stulas by stent-grafts have increased since Kerns et al fi rst reported this treatment in 1996.…”

“…[1][2][3][4][5][6][7][8][9] Previous pelvic surgery, radiation therapy, and indwelling of ureteral stents are closely associated with this fi stula. [1][2][3] The iliac arteries are the most commonly involved arteries.…”

“…Ureteroarterial fi stula has up to now been mainly treated by either surgery or a combination of surgery and arterial embolization 1,2,4,8 ; however, reports of treatment by other interventional methods using stent-grafts have increased. 3,[5][6][7]9 We present two patients with ureteroarterial fi stula who underwent successful endovascular treatment with the use of stent-grafts.…”