Rupture of an Aortic Anastomotic Aneurysm into a Ureter

Abstract

A case of rupture of a false aneurysm of the distal aorta into the left ureter is reported. The patient presented with purulent hydronephrosis and hematuria. A left aorto-femoral graft had been inserted 3 years earlier, which became infected and was then removed. After 2 years a false distal aortic aneurysm developed, and in the last 6 months recurrent episodes of hematuria have occurred. An aorto-ureteric fistula was confirmed at surgery, and a left nephrostomy was performed with proximal and distal ligation of the ureter and then aneurysmectomy followed by aorto-bifemoral bypass.

Endovascular Treatment of Aortoureteric Fistula

“…Ureteroarterial fistula can be difficult to diagnose because it is very rare and the first symptom is often intermittent hematuria, which is routine symptom after urological surgery. [1][2][3][4][5] Only ureterography and selective iliac arteriography have been relatively successful in identifying the fistula; however, there are a few cases with sudden major bleeding such as in our patient. 4,[6][7][8] Keller et al 6 reported that 89% of patients with the correct diagnosis recovered and were discharged from the hospital; in contrast, there was a 52% mortality rate associated with an unsuspected or undiagnosed ureteroarterial fistula.…”

“…Extra-anatomical arterial reconstruction and nephrectomy or nephrostomy were added if required. 2,3,5 Some authors recommend the use of transarterial embolization of the arteries with extra-anatomical bypass. 4,6 One of the most noteworthy postoperative complications of aortoureteric fistula is local infection, especially when artificial materials are used.…”

“…9,10 As countermeasures, the use of omental pedicles or rifampicin-impregnated graft were reported. 1,5,6 The treatment of massive hemorrhage from an aortoureteric fistula presents a different challenge. It is necessary to control bleeding immediately to maintain blood pressure.…”