Ureteroarterial fistula: A review of the literature

Abstract

Ureteroarterial fistulas are rare, erosive defects that occur between the distal segments of the ureter and the adjacent blood vessels in individuals with urologic and vascular comorbidities. Characterized by diffuse, pulsatile bleeding into the urinary tract, this condition carries a significant mortality rate in the absence of early recognition. Recent treatment efforts have focused on use of endovascular stenting techniques as an alternative to open surgical closure of the underlying defects in hemodynamically stable patients. We provide a literature review detailing the characteristics, mechanism, and management of ureteroarterial fistulas.

Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report

“…However, the reported diagnostic rates with CT are only 42-50% in cases without aneurysms, because it is often difficult to detect a direct fistulous communication between the artery and ureter via cross-sectional imaging (Van den Bergh et al 2009). The current review demonstrated that the angiography was the best modality for the diagnosis of UAF; however, the angiography could detect the bleeding in still only 72.4% (Das et al 2016). Contrast extravasation into the ureter might not occur when a ureteral stent or clots are at the site and tamponade the leak.…”

“…UAF is a rare complex problem involving multiple organ systems, usually occurring in patients with significant comorbid conditions due to malignancy, irradiation, previous surgical interventions and indwelling ureteral stents (Das et al 2016;Turo et al 2018). A previous report demonstrated that a pseudoaneurysm was detected in up to 38% of cases with UAF, and CT could show an enhancing mass near the crossing of the ureter (Van den Bergh et al 2009).…”

“…Baseline angiography did not show blood flow into the ureter from iliac arteries ( Fig. 2a and Additional file 3: Movie S3) (Das et al 2016). The CIA and EIA were too large for OPTICROSS IVUS™ compatible with 0.014-wires (Boston Scientific, MA, US) to identify the connection of the UAF.…”

“…UAF is classified into primary (15%) and secondary (85%) types based the cause (Pillai et al 2015). Secondary causes result from pelvic cancer (70.3%) and prior interventions including surgery (69.5%) combined with radiation (48.3%), and the most common risk factor was presence of a chronic indwelling ureteral stent (73.7%) (Das et al 2016). The mechanical fixation of the ureter appears to lead to inflammation and fibrosis in the adjacent artery during pulsation; however, the mechanism has not yet been fully evaluated using intravascular imaging.…”

Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter

“…Regarding treatments AUF requires multidisciplinary approach. Currently endovascular therapy is preferred to open surgery given the frequency of complicated anatomic presentation in most patients secondary to previous comorbidity [6]. …”