The Arterial Folding Point During Flexion of the Hip Joint

Abstract

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.

Infrainguinal open reconstruction: a review of surgical considerations and expected outcomes

“…However, endovascular therapies may compromise blood flow to the profunda femoris, which originates at the femoral bifurcation. Endovascular stents at the CFA are also susceptible to fracture and kinking due to frequent flexion and movement at the inguinal ligament 25,26. Stenting in the CFA has been associated with high risk of intervention in a recent study, although there remains a lack of consensus with conflicting published data 24,27,28.…”

Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery?

“…Traumatic aortic rupture with retroperitoneal haematoma can also be treated with a combined operative and endovascular approach (89). Posterior iatrogenic injury to the iliac artery can also be treated with a stent-graft, provided the position is not over the hip joint (90).…”

Assessing the Perioperative Safety of Common Femoral Endarterectomy in the Endovascular Era

“…Many vascular specialists believe that flexion at the inguinal ligament render the CFA an inhospitable environment for endovascular stents due to the likelihood of fracture and kinking. 11,12 Nonetheless, recent reports have identified many vascular specialists' willingness utilize ET to treat the disease of the CFA. [13][14][15][16] As durability concerns clearly favor surgical endarterectomy, the purported advantages of ET, as in other anatomic locations, are based on the claims of reduced perioperative morbidity and mortality in comparison to surgery.…”