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Yamamoto Y, Uchiyama H, Oonuki M. Extravascular Migration of a Stentgraft Into the Bladder: A Rare Complication After Endovascular Treatment of an Arterio-Ureteral Fistula. Vasc Endovascular Surg 2024; 58:90-94. [PMID: 37320969 DOI: 10.1177/15385744231183783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Endovascular repair has gained acceptance for the treatment of arterio-ureteral fistula (AUF). However, data on associated postoperative complications are relatively scarce. We report the case of a 59-year-old woman with an external iliac artery (EIA)-ureteral fistula treated by endovascular stentgraft placement. Hematuria resolved after the procedure; however, occlusion of the left EIA and migration of the stentgraft into the bladder occurred 3 months postoperatively. Endovascular repair is a safe and effective method for the treatment of AUF, but it needs to be carefully followed. Extravascular migration of a stentgraft is a rare but possible complication.
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Affiliation(s)
- Yohei Yamamoto
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masahiro Oonuki
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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2
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El Beyrouti H, Omar M, Calimanescu CT, Treede H, Halloum N. Paracolic Gutter Routing: A Novel Retroperitoneal Extra-Anatomical Repair for Infected Aorto-Iliac Axis. J Clin Med 2023; 12:5765. [PMID: 37685832 PMCID: PMC10488997 DOI: 10.3390/jcm12175765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVE We describe and analyze outcomes of a novel extra-anatomical paracolic gutter routing technique for surgical repair of aorto-iliac infections. METHODS A double-center, observational, cohort study of all consecutive patients with aorto-iliac infections treated using extra-anatomical paracolic gutter technique. Between May 2015 and December 2022, six patients with aorto-iliac infections were treated with the paracolic gutter routing technique. Cases were identified retrospectively in an institutional database, and data were retrieved from surgical records, imaging studies, and follow-up records. RESULTS Aorto-bifemoral vascular reconstructions were performed using this technique in six patients. During mean follow-up of 52 ± 44 months, there was one case of graft thrombosis (17%) with subsequent successful thrombectomy. Primary and secondary graft patency rates were 83% and 100%, respectively. There was one mortality (17%) due to candida sepsis. All graft prostheses were patent at last follow-up. CONCLUSIONS The paracolic gutter technique is a useful technique in patients with extensive aorto-iliac infections, arteriovenous and iliac-ureteric fistulas, or at a high risk of vascular graft infection and is associated with favorable reinfection and patency rates.
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Affiliation(s)
- Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Mohamed Omar
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | | | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
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3
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Özbilen MH, Kısa E, Çapar AE, İlbey YÖ. Life-threatening Arterioureteral Fistula Between Iliac Vessel and Ureteral Stump: A Case Report. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2021.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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García Martínez B, Calleja Hermosa P, Fernández Guzmán E, Jordá Lope J, Ballestero Diego R, Campos Juanatey F, Ramos Barseló E, Bustamante Sánchez SM, Gutiérrez Baños JL, Domínguez Esteban M. Arterial Fistulas in Urinary Diverted Patients: A Report of 5 Cases. Cardiovasc Intervent Radiol 2022; 45:1848-1854. [PMID: 36175658 DOI: 10.1007/s00270-022-03273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/26/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Arterio-urinary fistulae are a rare but potentially lethal complication that may arise after pelvic surgery, such as radical cystectomy. Historically, open surgery was the gold standard treatment, but currently endovascular treatment has gained prominence. METHODS We report our centre experience in endovascular treatment of cystectomy-related arterial fistulae and review the reported literature on the topic. During the postoperative period of radical cystoprostatectomy five patients presented different ranges of haematuria, and one presented rectal bleeding, four of them with haemodynamic instability. An urgent three-phase computed tomography was performed, showing active bleeding in 2 patients, while the rest of the patients presented indirect signs of fistulae. An angiography was performed, showing contrast extravasation in 60% of the cases and vessel wall irregularity in 40%. Five arteriourinary fistulae and one arterioenteric fistula were urgently treated with a covered stent placement, sealing the site of the fistula in the artery. RESULTS Immediate results were satisfactory in all cases; however, one patient died secondary to fistula-related causes 15 days post-treatment. No stent thrombosis or rebleeding have been registered during follow-up. In this review, reported results and complications after covered stent placement are shown, and controversial topics such as antibiotic coverage and antithrombotic treatment after endovascular treatment are also reviewed.
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Affiliation(s)
- Beatriz García Martínez
- Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain.
| | | | | | - Juan Jordá Lope
- Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain
| | | | | | | | - Secundino Manuel Bustamante Sánchez
- Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain
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Challenges in Diagnosis of Uretero–Arterial Fistulas after Complex Pelvic Oncological Procedures—Single Center Experience and Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12081832. [PMID: 36010182 PMCID: PMC9406295 DOI: 10.3390/diagnostics12081832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Uretero–arterial fistula (UAF) represents a rare condition that manifests as massive or intermittent hematuria and requires collaboration between a urologist, vascular surgeon and interventional radiologist. In this article, we present our experience with UAF diagnosis, treatment pathways and the results of a nonsystematic review of the literature published in the last decade regarding modern diagnostic procedures. Material and method: We analyzed the clinical data of nine consecutive patients from our institution diagnosed with UAF in the interval of 2012–2022 who underwent open or endovascular surgical treatment. We reviewed patient characteristics, diagnoses and treatment pathways. The literature search resulted in 14 case series, published from 2012 to 2022, describing a total of 670 cases of UAF. Results: The mean age of patients in our cohort was 65.3 years (IQR: 51–79). UAFs were more common in women (77.7%). All patients presented a history of surgical intervention and ir-radiation for pelvic malignancy with permanent ureteric stenting. Overall, 88.8% of patients had urinary diversion, either via ileal conduit or cutaneous ureterostomy. The most common clinical manifestation of UAF was gross hematuria with or without clots accompanied by flank pain due to stent obstruction, while three patients presented with hypovolemic shock. Angiography represents the best option for diagnosis, followed by angioCT, with a sensitivity of 59.83% and 47.01%, respectively. There is no definitive imaging modality associated with high accuracy in detecting UAF and negative findings do not exclude the disease. In emergency cases with massive bleeding, surgical exploration remains the most appropriate management option for both diagnosis and treatment. Endovascular stent graft placement is preferred over open surgery in stable hemodynamic patients. Conclusions: Uretero–arterial fistulas represent a life-threatening complication and must be treated with great awareness. Angiography represents the best modality for diagnosis, followed by computed tomography. However, there is no definitive imaging modality and, in some cases, open approach remains the only option for diagnosis and treatment.
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Saleem M, Pahuja KH, Arnouk A. Pelvic Irradiation: A Rare Cause of Concomitant Radiation Cystitis and Uretero-Iliac Artery Fistula Causing Gross Hematuria and Hemorrhagic Shock. Cureus 2022; 14:e25774. [PMID: 35812545 PMCID: PMC9270654 DOI: 10.7759/cureus.25774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
Uretero-iliac artery fistulas (UIAFs) are a rare cause of gross hematuria. They form as a result of poorly vascularized uretero-iliac adhesions and the resultant fibrosis and chronic inflammatory changes. Causes include previous pelvic surgery, radiotherapy, and chronic ureteral stenting. The presentation is usually intermittent massive gross hematuria with acute anemia and hemorrhagic shock. A high index of suspicion is warranted in patients with predisposing factors for prompt diagnosis and management as it may be associated with life-threatening hemorrhage. Due to the intermittent nature of symptoms, identification is not always apparent. Open surgical repair was the treatment of choice in the past. With advancements in interventional radiology techniques, endovascular stenting of the iliac artery and concomitant ureteral stenting is the current treatment of choice. We report a case of massive gross hematuria leading to hemorrhagic shock with underlying UIAF and predisposing risk factor of pelvic irradiation. Our case report describes the diagnostic challenges with associated comorbid conditions causing delays in successful management.
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Rosales Morales R, Rigberg DA. A multidisciplinary case of ureteroiliac fistula after radical cystectomy. J Vasc Surg Cases Innov Tech 2022; 8:53-56. [PMID: 35097249 PMCID: PMC8783110 DOI: 10.1016/j.jvscit.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
Ureteroiliac fistula is a rare complication associated with ureteral stenting and iliac artery reconstruction and can lead to life-threatening hemorrhage. We report a case of acute bleeding from a ureteroiliac fistula in an 89-year-old man with bladder cancer who had undergone pelvic radiation, radical cystectomy, and ileal conduit complicated by ureteral strictures requiring routine stent exchanges. Multidisciplinary diagnostic therapies revealed the fistula, which was treated with hypogastric artery coiling and covered stent placement. No further bleeding issues had resulted from the fistula at 11 months of follow-up. The presence of a ureteroiliac fistula should be considered in any patient with a similar history.
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Affiliation(s)
| | - David A. Rigberg
- Division of Vascular Surgery, University of California, Los Angeles, Calif
- Correspondence: David A. Rigberg, MD, Division of Vascular Surgery, University of California, 200 UCLA Medical Plaza, Suite 526, Los Angeles, CA 90095
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Altaha MA, Tarulli M, Bajwa J, Mafeld S, Jaberi A. Endovascular coil embolization of inferior mesenteric artery to ileal-conduit fistula: a case report. BMC Urol 2022; 22:11. [PMID: 35101008 PMCID: PMC8802439 DOI: 10.1186/s12894-022-00961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uretero-arterial fistulas (UAFs) are uncommon and pose a diagnostic dilemma, making them life threatening if not recognized and treated expediently. UAFs to small arteries such as a branch of the inferior mesenteric artery (IMA) are very uncommon and present a further diagnostic and treatment challenge. There should be a high index of suspicion for UAFs when intervening on patients with history of treated pelvic cancers and long-standing ureteric stents experiencing hematuria not attributable to another cause. CASE PRESENTATION We present a case of a fistula formed between a distal branch of the IMA-superior rectal artery-and an ileal-conduit in a patient with a long-standing reverse nephroureterostomy (Hobbs) catheter presenting with abdominal pain and hematuria through the conduit. During a tube exchange, contrast injection demonstrated a fistula with the superior rectal artery, multiple ileal intraluminal blood clots, and active extravasation. The patient became tachycardic and hypotensive, actively bleeding through the ileal-conduit, prompting a massive transfusion protocol. Successful endovascular coiling of the superior rectal artery was performed with resolution of active extravasation and stabilization of the patient. The patient recovered and was discharged in stable condition 10 days later. CONCLUSIONS Although UAFs are uncommon, our case demonstrated key predisposing risk factors to fistula development; pelvic cancer surgery, pelvic radiation, and a prolonged ureteric stent through the ileal-conduit. Typically, UAFs arise from communication with the iliac arterial system, however in this instance we have demonstrated that fistulization to other arterial vessels is also possible. Endovascular management has become the preferred method of therapy, typically involving the placement of covered stents when involving the iliac arterial system. In this instance stent grafting was not possible due to the small caliber vessel and therefore had to be embolized.
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Affiliation(s)
- Mustafa A Altaha
- Division of Interventional Radiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada. .,Diagnostic and Interventional Radiology Resident, Joint Department of Medical Imaging, University of Toronto, 1 Dunsmore Gdns., Toronto, ON, M3H 3M1, Canada.
| | - Massimo Tarulli
- Division of Interventional Radiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Jaspreet Bajwa
- Division of Interventional Radiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Diagnostic and Interventional Radiology Resident, Joint Department of Medical Imaging, University of Toronto, 1 Dunsmore Gdns., Toronto, ON, M3H 3M1, Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Arash Jaberi
- Division of Interventional Radiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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Ghouti C, Leon G, Seddik S, Ait Said K, Vaudreuil L, Tillou X. Uretero-arterial fistula: Six new cases and systematic review of the literature. Prog Urol 2021; 31:605-617. [PMID: 34158218 DOI: 10.1016/j.purol.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 10/21/2022]
Abstract
AIM Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. METHODS Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords "arterio-ureteral fistula", "arterio iliac fistula" and "ilio-ureteral fistula". We excluded uretero-arterial fistula following vascular surgery. RESULTS Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. CONCLUSION SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. LEVEL OF PROOF 3.
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Affiliation(s)
- C Ghouti
- Urology department, University Hospital Caen, Caen, France
| | - G Leon
- Urology department, University Hospital Caen, Caen, France
| | - S Seddik
- Urology department, University Hospital Caen, Caen, France
| | - K Ait Said
- Urology department, University Hospital Caen, Caen, France
| | - L Vaudreuil
- Urology department, University Hospital Caen, Caen, France
| | - X Tillou
- Urology department, University Hospital Caen, Caen, France.
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Simon B, Neubauer J, Schoenthaler M, Hein S, Bamberg F, Maruschke L. Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature. CVIR Endovasc 2021; 4:36. [PMID: 33864536 PMCID: PMC8053137 DOI: 10.1186/s42155-021-00226-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment. Methods This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management. Results We identified 17 UAF in 16 patients (12 male, 4 female, mean age 69.8 ± 11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1–3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases (82.4%). Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%). Conclusion Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary. Evidence-based medicine Level 4, case series.
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Affiliation(s)
- Bjoern Simon
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jakob Neubauer
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schoenthaler
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Hein
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lars Maruschke
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Diagnostic Radiology, Pediatric Radiology and Interventional Radiology, St.-Josefs-Krankenhaus, Freiburg, Germany
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Systematic Review of the Management of Ureteroarterial Fistulas After Ileal Conduit Urinary Diversion. AJR Am J Roentgenol 2021; 216:1452-1461. [PMID: 33787298 DOI: 10.2214/ajr.20.23132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. No studies or guidelines exist to direct management of ureteroarterial fistula (UAF) after ileal conduit urinary diversion in which the possible risks and complications associated with stent-graft infection from the conduit flora must be reconciled with those of open surgical repair. This study seeks to characterize the clinical presentation, pathogenesis, and optimal diagnostic and therapeutic management of this entity through a systematic review of the literature. MATERIALS AND METHODS. A systematic search of the English-language literature using the PubMed, Scopus, and ScienceDirect databases was performed: 264 abstracts were identified. From those abstracts, 32 studies comprising 40 patients with 43 UAFs were selected for analysis. Data points including demographics, clinical presentation, UAF specifications, procedural details, postprocedural complications, and clinical outcomes were reviewed. RESULTS. Predisposing factors included female sex, chronic ureteral stent placement, and past surgical intervention and irradiation for pelvic malignancy. Fistulization was overwhelmingly unilateral (95.0% of patients) and included the common iliac artery (90.7% of UAFs). Combined endovascular and endoureteral modalities presented similar outcomes compared with surgical approaches in terms of UAF-related mortality (7.1% vs 13.3%, respectively) and complication rates (28.6% vs 26.7%) during a similar median follow-up period (9.5 vs 14.0 months). Endovascular stent-graft infections were present in 14.3% of cases and represented a leading indication for reintervention after endovascular management (50.0%). CONCLUSION. Short- and intermediate-term outcomes of combined endovascular and endoureteral techniques compare favorably with those of surgical approaches in the treatment of UAF after ileal conduit urinary diversion. Although there is a relatively low stent-graft infection rate, close follow-up within the first year after the procedure is required given the propensity of complications to develop during this window. The use of postprocedural antibiotics is uncertain but is likely prudent.
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12
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Abbas AIA, Salhanick M, Kirkwood ML. Uretero-Arterial Fistula: A Case Report and Review of the Literature. Vasc Endovascular Surg 2020; 55:415-418. [PMID: 33334245 DOI: 10.1177/1538574420976731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Uretero-arterial fistula (UAF) is a rare complication of either aneurysmal disease primarily or pelvic inflammation secondary to urologic, oncologic, or vascular interventions. Diagnosis can be difficult to confirm and treatment may need to proceed on high index of suspicion alone. We present the case of a 56-year-old woman suffering from intermittent hematuria after laser lithotripsy leading to UAF between her left ureter and left Dacron aortobifemoral bypass limb. The fistula was successfully treated with endovascular intervention.
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Affiliation(s)
- Amr I Al Abbas
- Department of Surgery, 25989University of Texas Southwestern, Dallas, TX, USA
| | - Marc Salhanick
- Division of Vascular Surgery, 25989University of Texas Southwestern, Dallas, TX, USA
| | - Melissa L Kirkwood
- Division of Vascular Surgery, 25989University of Texas Southwestern, Dallas, TX, USA
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13
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Badia D, Hillard B, Ritchie C, Miller MD, Orr N, Tyagi S. Ureteral Arterial Fistula - A Role for Open Operation in the 21st Century. Ann Vasc Surg 2020; 74:518.e1-518.e5. [PMID: 33333182 DOI: 10.1016/j.avsg.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ureteral arterial fistula is a rare and challenging clinical entity. The diagnosis and management of ureteral arterial fistula present a unique disease process that requires a dual specialty approach, involving both vascular and urologic surgeons. There are different options for repair, including both open and endovascular techniques. METHODS AND RESULTS A 78-year-old male presented to the emergency department (ED) in septic shock secondary to a urinary tract infection and was admitted to the intensive care unit (ICU) for further management and resuscitation. The patient had previously undergone radical cystoprostatectomy with ileal conduit creation in 2011 for recurrent bladder cancer. Following creation of his ileal conduit, he required long-term indwelling ureteral stents bilaterally due to recurrent stricturing at the ureteroneocystostomy with stent exchanges performed 2-3 times per year due to frequent urinary tract infections. During his hospitalization for sepsis, the urology service performed an exchange of his left indwelling ureteral stent. However, pulsatile bleeding was observed from the junction of the ileal conduit and left ureter. The stent was replaced at the bedside, and the bleeding ceased. Vascular surgery consultation and a computed tomography angiogram (CTA) gave support to the diagnosis of a ureteral arterial fistula. A plan was developed to exchange the stent in the operating room with vascular surgery assistance. It was determined that a definitive open repair with excision of the fistula would be the most appropriate course. CONCLUSIONS In the setting of hemodynamically significant bleeding, we recommend an endovascular approach to obtain hemostasis. However, an open approach provides both reconstruction and infectious resistance in an already soiled field. Open repair may provide a more definitive reconstruction.
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Affiliation(s)
- Daniel Badia
- Department of Surgery, Section of Vascular Surgery, University of Kentucky, Lexington, KY
| | - Brent Hillard
- Department of Surgery, Section of Vascular Surgery, University of Kentucky, Lexington, KY
| | - Cheryl Ritchie
- Department of Surgery, Section of Vascular Surgery, University of Kentucky, Lexington, KY; Department of Surgery, NW Permanente, PC, Physicians and Surgeons, Clackamas, Oregon
| | - Mark D Miller
- Department of Surgery, Section of Vascular Surgery, University of Kentucky, Lexington, KY
| | - Nathan Orr
- Department of Surgery, Section of Vascular Surgery, University of Kentucky, Lexington, KY
| | - Samuel Tyagi
- Department of Surgery, Section of Vascular Surgery, University of Kentucky, Lexington, KY.
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14
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Kobayashi K, Goel A, Coelho MP, Medina Perez M, Klumpp M, Tewari SO, Appleton-Figueira T, Pinter DJ, Shapiro O, Jawed M. Complications of Ileal Conduits after Radical Cystectomy: Interventional Radiologic Management. Radiographics 2020; 41:249-267. [PMID: 33306453 DOI: 10.1148/rg.2021200067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since their introduction into clinical practice in the 1950s, ileal conduits have been the most common type of urinary diversion used after radical cystectomy worldwide. Although ileal conduits are technically simpler to construct than other forms of urinary diversion, a variety of complications can occur in the early and late postoperative periods. Early complications include urine leakage, urinary obstruction, postoperative fluid collection (eg, urinoma, hematoma, lymphocele, or abscess), and fistula formation. Late complications include ureteroileal anastomotic stricture, stomal stenosis, conduit stenosis, and urolithiasis. Although not directly related to ileal conduits, ureteroarterial fistula can occur in patients with an ileal conduit. Interventional radiologists can play a pivotal role in diagnosis and management of these complications by performing image-guided minimally invasive procedures. In this article, the authors review the surgical anatomy of an ileal conduit and the underlying pathophysiology of and diagnostic workup for complications related to ileal conduits. The authors also discuss and illustrate current approaches to interventional radiologic management of these complications, with emphasis on a collaborative approach with urologists or endourologists to best preserve patients' renal function and maintain their quality of life. ©RSNA, 2020.
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Affiliation(s)
- Katsuhiro Kobayashi
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Atin Goel
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Marlon P Coelho
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Mariangeles Medina Perez
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Matthew Klumpp
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Sanjit O Tewari
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Tomas Appleton-Figueira
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - David J Pinter
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Oleg Shapiro
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
| | - Mohammed Jawed
- From the Departments of Radiology (K.K., A.G., M.P.C., M.M.P., M.K., S.O.T., T.A.F., D.J.P., M.J.), and Urology (O.S.), SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY 13210
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15
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Omran S, Schäfer H, Kapahnke S, Müller V, Bürger M, Konietschke F, Frese JPB, Neymeyer J, Greiner A. Endovascular and open surgical options in the treatment of uretero-arterial fistulas. Vascular 2020; 29:672-681. [DOI: 10.1177/1708538120970823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To report and analyze the indications and results of endovascular and open surgical treatment for uretero-arterial fistula. Methods We retrospectively reviewed the clinical data of 25 consecutive patients with uretero-arterial fistulas admitted to our hospital from 2011 to 2020. Endpoints were technical success, freedom from open conversion, stent-graft/graft-related complications, and 30-day and one-year mortality. Results The study included 25 patients (68% female, n = 17) with 27 uretero-arterial fistulas by bilateral pathologies in two patients. The mean age was 61 ± 11 years (range 35–80). The most common predisposing factors for uretero-arterial fistula were history of pelvic operations for malignancy in 21 patients (84%), radiotherapy in 21 patients (84%), previous pelvic vascular bypass in 2 patients (8%), and iliac aneurysms in 2 patients (8%). On average, the period between the primary pelvic surgery and the diagnosis of uretero-arterial fistulas was 46 months (range 7–255). Twenty patients (80%) underwent endovascular treatment of the uretero-arterial fistulas. The primary technical success of the endovascular treatment was 95%, and the freedom from open conversion was 40% at six months and 30% at one year. Thirteen uretero-arterial fistulas (48%) underwent delayed open conversion due to recurrent bleeding in six cases (46%), stent-graft infection in three cases (23%), or pelvic abscess in four cases (31%). Primary open surgery was applied for five (20%) patients. After a mean follow-up of 34 months, early (<30 days) mortality was 8% (2/25), one-year mortality 16% (4/25), and overall mortality was 24% (6/25). Conclusions Uretero-arterial fistula is a late complication of prior pelvic surgery, radiation, and indwelling ureteral stents. Endovascular treatment remains an effective and less invasive modality in controlling the related life-threatening arterial bleeding of the uretero-arterial fistula. Open surgical treatment is still required for patients with local sepsis, previously failed endovascular treatment or infected stent-grafts.
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Affiliation(s)
- Safwan Omran
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Hannah Schäfer
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Sebastian Kapahnke
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Verena Müller
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Matthias Bürger
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Frank Konietschke
- Institute of Medical Biometrics and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Jan Paul Bernhard Frese
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Jörg Neymeyer
- Clinic of Urology, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
| | - Andreas Greiner
- Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité – Universitätsmedizin, Berlin, Germany
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16
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Miyauchi Y, Osaki Y, Naito H, Tsunemori H, Itoh M, Kanenishi K, Norikane T, Sanomura T, Nishiyama Y, Sugimoto M. Ureteroiliac artery fistula caused by full-length metallic ureteral stenting in a malignant ureteral obstruction: a case report. J Med Case Rep 2020; 14:195. [PMID: 33070773 PMCID: PMC7569756 DOI: 10.1186/s13256-020-02532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/14/2020] [Indexed: 11/14/2022] Open
Abstract
Background The metallic stent is a new device for relieving the urinary tract in patients with malignant ureteral obstruction with short life expectancy and has been used frequently worldwide for its efficacy and safety. A ureteroarterial fistula with indwelling ureteral stent is rare but highly fatal, and there are several reports of ureteroarterial fistula treated by conventional polymer stents, although there are no reports on metallic stents. To our knowledge, this paper describes the first case of a ureteroiliac artery fistula caused by a full-length metallic ureteral stent in malignant ureteral obstruction. Case presentation Our patient was a 57-year-old Asian woman with a history of locally advanced cervical cancer who underwent abdominal total hysterectomy and chemoradiotherapy. She was diagnosed with right hydronephrosis and hydroureter secondary to upper ureteral obstruction because of retroperitoneal lymph node metastasis. A urinary tract obstruction after placement of 12 months of polymer stent followed by 18 months of metallic stent was relieved, consequently resulting in intermittent gross hematuria with bladder tamponade and anemia. Contrast-enhanced computed tomography could not reveal a ureteroarterial fistula; however, retrograde pyelography emphasized the existence of a ureteroiliac artery fistula. The patient underwent successful endovascular heparin-bonded stent graft placement, and her gross hematuria disappeared thereafter. Conclusion The metallic stent is a useful device for patients with malignant ureteral obstruction with a short life expectancy, although it may impose a higher pressure on the extraureteral tissue than conventional polymer stents due to its properties and may cause a ureteroarterial fistula. The narrowing of the external iliac artery diameter visualized by computed tomography may be helpful for predicting ureteroarterial fistulas.
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Affiliation(s)
- Yasuyuki Miyauchi
- Department of Urology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho. Kita-gun, Kagawa, 761-0793, Japan.
| | - Yu Osaki
- Department of Urology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho. Kita-gun, Kagawa, 761-0793, Japan
| | - Hirohito Naito
- Department of Urology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho. Kita-gun, Kagawa, 761-0793, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho. Kita-gun, Kagawa, 761-0793, Japan
| | - Megumi Itoh
- Department of Perinatology and Gynecology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University Faculty of Medicine, Kagawa, Japan
| | - Takashi Norikane
- Department of Radiology, Kagawa University Hospital, Kagawa, Japan
| | | | | | - Mikio Sugimoto
- Department of Urology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki-cho. Kita-gun, Kagawa, 761-0793, Japan
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17
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Tijunaitis K, Mosenko V, Baltrūnas T. A Bleeding Uretero-Arterial Fistula: Open Repair After Unsuccessful Endovascular Treatment. Vasc Endovascular Surg 2020; 55:171-176. [PMID: 32873221 DOI: 10.1177/1538574420953964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Uretero-arterial fistula (UAF) poses major challenges in management and diagnosis due to the rarity of this condition and associated high morbidity/mortality rates. METHODS We describe a case of a UAF associated with previous aorto-biiliac grafting, ureteric stenting and right nephrectomy because of chronic pielonephritis and complicated by surgical site infection. This case illustrates a very complex pathology, with a challenging diagnosis and multiple treatment options. RESULTS A 72 year-old woman was referred to Vilnius Vascular Unit for open UAF repair. The patient had a history of open abdominal aortic aneurysm repair using a bifurcated graft 25 years ago. The right ureter was injured during the operation and a rigid indwelling ureteric stent was inserted. Six months prior to referral, she underwent a right nephrectomy due to a chronic pyelonephritis, complicated by surgical site infection, which was still present at the time of admission. Initial CTA demonstrated bilateral iliac aneurysms, but no signs of UAF. A further CTA revealed a UAF between the right ureteral stump and the right common iliac artery (CIA) para-anastomotic aneurysm. After unsuccessful attempts to embolize the UAF using both coils and glue, the patient was referred to Vilnius Vascular Unit for open repair. Left axillo-bifemoral bypass reconstruction was performed followed by UAF repair and bifurcated graft explantation. Follow-up after 2 years showed no recurrence of haematuria, good function of the remaining kidney and patent axillo-bifemoral bypass with no signs of infection around the prosthetic aortic stump. CONCLUSIONS Uretero-arterial fistula is a uncommon condition in everyday clinical practice. The rarity of this condition may lead to delayed or missed diagnosis which can result in life-threating consequences. A multidisciplinary approach involving urologists, vascular surgeon and radiologist are crucial to both the diagnosis and managment of this rare entity.
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Affiliation(s)
| | - Valerija Mosenko
- 68626Vilnius University Faculty of Medicine, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Tomas Baltrūnas
- 58939Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
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18
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Tatsuishi W, Konno N, Hatori K, Yoshizumi T, Shibuya K, Abe T. Successful Endovascular Repair of a Ruptured Common Iliac Artery Aneurysm Associated with an Ileal Pouch Neobladder Fistula. Ann Vasc Surg 2020; 69:448.e9-448.e13. [PMID: 32473305 DOI: 10.1016/j.avsg.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
A spontaneous fistula between a ruptured common iliac artery aneurysm and the ileal pouch neobladder is quite rare. We present the case of a 74-year-old man presenting with intense abdominal pain and massive hematuria. Computed tomography angiography revealed a ruptured common iliac artery aneurysm-ileal pouch neobladder fistula. His hemodynamics was unstable; emergent endovascular aortic repair was performed successfully. Infection and dysfunction of the neobladder were avoided owing to appropriate management.
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Affiliation(s)
- Wataru Tatsuishi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan.
| | - Naoki Konno
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
| | - Kyohei Hatori
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
| | - Tomo Yoshizumi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
| | - Kei Shibuya
- Department of Radiology, Gunma University, Maebashi, Gunma, Japan
| | - Tomonobu Abe
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
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19
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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Jaha L, Ismaili-Jaha V, Ademi B, Veselaj F, Kryeziu D, Gjikolli B, Gecaj-Gashi A, Koshi A, Jaha A. Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report. J Med Case Rep 2019; 13:359. [PMID: 31812163 PMCID: PMC6899332 DOI: 10.1186/s13256-019-2300-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter. CASE PRESENTATION We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up. CONCLUSION The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery remains the best treatment option, although there is increasing evidence of successful endovascular treatment.
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Affiliation(s)
- Luan Jaha
- Department of Vascular Surgery, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Vlora Ismaili-Jaha
- Faculty of Medicine, University “Hasan Prishtina”, Rrethi i Spitalit p.n., 10000 Prishtina, Republic of Kosovo
| | - Bekim Ademi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Fahredin Veselaj
- Department of Urology, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Destan Kryeziu
- Department of Urology, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Bujar Gjikolli
- Department of Radiology, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Agreta Gecaj-Gashi
- Department of Anesthesiology and Intensive Care, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Adhurim Koshi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Art Jaha
- Faculty of Medicine, University “Hasan Prishtina”, Rrethi i Spitalit p.n., 10000 Prishtina, Republic of Kosovo
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21
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Yamazaki H, Nakamura T, Otsuki Y, Tsuchiya M, Hamano T, Adachi H. Sudden fatal bleeding from a uretero-arterial fistula combined with pre-existing uretero-colic and uretero-vaginal fistulas 7 years after a cervical cancer surgery: a case report. Surg Case Rep 2019; 5:85. [PMID: 31123939 PMCID: PMC6533329 DOI: 10.1186/s40792-019-0642-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background Uretero-arterial fistulas (UAFs) are a rare cause of hematuria and could be fatal often due to a diagnostic delay despite recent advances in the treatment modalities. Case presentation A 52-year-old woman with a history of advanced cervical cancer developed a fever and was diagnosed with a left uretero-colic fistula. She also had a uretero-vaginal fistula and suffered from repeated urinary tract infections over 6 years. While waiting for an elective colostomy, she developed sudden perineal bleeding and died 14 h after the onset. The autopsy findings revealed that bleeding from a newly developed UAF spreads out to the extracorporeal space through the pre-existing fistulas. Conclusions Bleeding from a UAF complicated by other uretero-genital and/or uretero-enteric fistulas could proceed rapidly resulting in a fatal outcome because of a lack of a tamponade effect. Early recognition of a UAF in high-risk patients is crucial for a prompt diagnosis, which might lead to a treatment success.
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Affiliation(s)
- Hiroki Yamazaki
- Department of Gynecology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan.
| | - Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Mitsuteru Tsuchiya
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Takashi Hamano
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Hiroshi Adachi
- Department of Gynecology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
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22
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Gao Q, Zhao J, Yang N, Jin Z. Endovascular management of arterio-ureteral fistula in a patient with a challenging hematuria. MINIM INVASIV THER 2019; 28:317-320. [PMID: 30648476 DOI: 10.1080/13645706.2018.1534742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Qinzong Gao
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Jing Zhao
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Ning Yang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
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23
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Turo R, Hadome E, Somov P, Hamid B, Gulur DM, Pettersson BA, Awsare NS. Uretero-Arterial Fistula - Not So Rare? Curr Urol 2018; 12:54-56. [PMID: 30374282 DOI: 10.1159/000489419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/07/2018] [Indexed: 12/11/2022] Open
Abstract
The first uretero-arterial fistula (UAF) was reported in 1908 by Moschcowitz. In 2009, a systematic review identified 139 cases. Since then a further 23 cases were described with 19 cases originating from a single center. It has been recognized as a very rare condition in the past. However, more recently, the increasing incidence of UAF has led us to believe that this condition is more frequent than previously described. Aging population, improved cancer survival and extensive multimodal pelvic cancer treatments have been recognized as culprits for the increased incidence of UAFs. We have reviewed literature on UAFs, identified risk factors, patho-physiology and treatment options. Also, we present a case of fistulous communication between the internal iliac artery and ureter in a patient with a potential risk factor previously not described in the literature.
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Affiliation(s)
- Rafal Turo
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Ewere Hadome
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Pavlo Somov
- Department of Urology, Countess of Chester Hospital, Chester, UK
| | - Bushra Hamid
- Department of Histopathology, Countess of Chester Hospital, Chester, UK
| | - Dev Mohan Gulur
- Department of Urology, Countess of Chester Hospital, Chester, UK
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24
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Chandrasekar T, Pugashetti N, Klaassen Z, Goldberg H, Dong P, Yap SA. Two Cases of Arterioureteral Fistula in the Setting of Previous Radiation Therapy and Indwelling Ureteral Stents: Results of Endovascular Management. Clin Genitourin Cancer 2018; 16:e979-e983. [PMID: 29776676 DOI: 10.1016/j.clgc.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/08/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Thenappan Chandrasekar
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Neil Pugashetti
- Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA
| | - Zachary Klaassen
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Paul Dong
- Division of Interventional Radiology, Department of Radiology, University of California, Davis, School of Medicine, Sacramento, CA
| | - Stanley A Yap
- Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA
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25
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Heers H, Netsch C, Wilhelm K, Secker A, Kurtz F, Spachmann P, Viniol S, Hofmann R, Hegele A. Diagnosis, Treatment, and Outcome of Arterioureteral Fistula: The Urologist's Perspective. J Endourol 2018; 32:245-251. [DOI: 10.1089/end.2017.0819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Hendrik Heers
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
| | | | - Konrad Wilhelm
- Department of Urology, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
| | - Armin Secker
- Department of Urology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Florian Kurtz
- Department of Urology, Technische Universität München, Munich, Germany
| | - Philipp Spachmann
- Department of Urology, Krankenhaus St. Josef, University of Regensburg, Regensburg, Germany
| | - Simon Viniol
- Department of Diagnostic and Interventional Radiology, Philipps-Universität Marburg, Marburg, Germany
| | - Rainer Hofmann
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
| | - Axel Hegele
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
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26
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Subiela JD, Balla A, Bollo J, Dilme JF, Soto Carricas B, Targarona EM, Rodriguez-Faba O, Breda A, Palou J. Endovascular Management of Ureteroarterial Fistula: Single Institution Experience and Systematic Literature Review. Vasc Endovascular Surg 2018; 52:275-286. [DOI: 10.1177/1538574418761721] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors’ hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review. Methods: Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: “uretero arterial fistula” and “uretero iliac fistula.” It includes only articles reporting the endovascular management. Results: Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1). Conclusion: Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.
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Affiliation(s)
- José D. Subiela
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Andrea Balla
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of General Surgery and Surgical Specialties “Paride Stefanini,” Sapienza, University of Rome, Rome, Italy
| | - Jesús Bollo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jaume F. Dilme
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Begoña Soto Carricas
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Eduard M. Targarona
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
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Lara-Hernández R, Riera Vázquez R, Benabarre Castany N, Sanchis P, Lozano Vilardell P. Ureteroarterial Fistulas: Diagnosis, Management, and Clinical Evolution. Ann Vasc Surg 2017; 44:459-465. [DOI: 10.1016/j.avsg.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
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Miguel-Sánchez AM, Sarmiento-Marasovic L, Buisán-Bardají JM, Coghi-Granados J, Duato Jané Á. Endovascular repair of an arterial pseudoaneurysm due to ureteral-iliac fistula. Cir Esp 2017; 96:124-126. [PMID: 28734524 DOI: 10.1016/j.ciresp.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/19/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Ana María Miguel-Sánchez
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | - Jose Manuel Buisán-Bardají
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Jorge Coghi-Granados
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Ángel Duato Jané
- Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter. Case Rep Urol 2017; 2017:9453618. [PMID: 28465857 PMCID: PMC5390552 DOI: 10.1155/2017/9453618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 11/23/2022] Open
Abstract
Arterioureteral fistulas (AUF) are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent.
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30
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Kibrik P, Eisenberg J, Bjurlin MA, Marks N, Hingorani A, Ascher E. Endoureteral coil embolization of an ureteral arterial fistula. Vascular 2017; 25:557-560. [PMID: 28436317 DOI: 10.1177/1708538117704522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Ureteral arterial fistulas are rare but potentially life threatening. We present a female who developed a ureteral arterial fistula following a right robotic nephrectomy. After several endovascular interventions to control the bleeding had failed, we approached the fistula through the right ureteral stump with coil embolization. Methods Coil embolization of the right ureteral stump was performed. We utilized a 6Fr × 45 cm sheath inserted through one of the cystoscope channels to cannulate the right ureteral orifice. We then performed a retrograde ureterogram. After, we were able to visualize full length of the ureter, ahd we began placing several 10-12 mm Nester coils to pack the ureter and tamponade the fistula for hemostasis. After the ureter was packed, we injected 1 g of Vancomycin into the ureter. The sheath and cytoscope were removed and the patient did well and was sent to the recovery room. Results Postoperatively, the patient had no complaints of hematuria and her hemoglobin level remained unchanged. She was observed for a few days prior to being discharged to home. The patient's follow-up at six months revealed resolution of her hematuria. Conclusion Ureteral arterial fistula is a potentially life-threatening condition. Endovascular stenting has provided a safe, reliable alternative to open surgery. However, when endovascular options are not satisfactory, coil embolization of the ureteral stump may serve as a safe and effective alternative treatment for these cases.
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31
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Rittenberg L, Nordsiek M, Cahn D, Zhang K, Taylor N, Ginsberg P. Diagnosis and Management of a Challenging Patient: Ureteroarterial Fistula. Urology 2016; 97:e9-e10. [DOI: 10.1016/j.urology.2016.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/27/2016] [Accepted: 07/15/2016] [Indexed: 02/03/2023]
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32
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Management Strategy for Ureteral-Iliac Artery Fistula. Ann Vasc Surg 2016; 36:22-27. [PMID: 27354319 DOI: 10.1016/j.avsg.2016.02.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/04/2016] [Accepted: 02/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ureteral-iliac artery fistula (UIAF) is a rare but a potentially life-threatening condition. In this study, we reported our results of UIAF treated by open surgical and endovascular treatment. METHODS In this single-center, retrospective observational cohort study, we reviewed 6 consecutive patients who were diagnosed with a UIAF and received either open surgical or endovascular treatment based on the specific risk profile of each patient. RESULTS All patients had an indwelling ureteral stent for a ureteral stricture, with an average ureteral stenting duration of 22 months (range, 1-74 months), and 2 patients had a history of endovascular treatment with stent grafts for UIAF. Contrast-enhanced computed tomographic angiography was positive in 4 patients. Blood and urine cultures were positive in 2 and 4 patients, respectively. Four patients, including 2 with previously failed endovascular treatment, received open surgical repair. The remaining 2 patients received either endovascular treatment with stent grafts or a hybrid procedure. During the mean follow-up period of 20.3 months (range, 6-29 months), there was no symptomatic recurrence of the UIAF. CONCLUSIONS A multidisciplinary approach is highly preferable for treating potentially life-threatening UIAF. Endovascular treatment with stent grafts is currently recommended in selected patients whenever possible, but open surgical treatment is required in certain patients with enteric contamination, abscess, local sepsis, or previously failed endovascular treatment.
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33
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Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula. Case Rep Radiol 2016; 2016:8682040. [PMID: 27293944 PMCID: PMC4880677 DOI: 10.1155/2016/8682040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/26/2016] [Indexed: 12/03/2022] Open
Abstract
Active extravasation via an arterioureteral fistula (AUF) is a rare and life-threatening emergency that requires efficient algorithms to save a patient's life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.
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34
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Smeds MR, Duncan AA, Harlander-Locke MP, Lawrence PF, Lyden S, Fatima J, Eskandari MK, Steenberge SP, Tomita TM, Morasch M, Jim J, Lyons LC, Charlton-Ouw K, Mushtaq H, Leake SS, Motaganahalli R, Nelson P, Parkerson G, Shalhub S, Bove P, Modrall G, Davila V, Money S, Hedayati N, Abou-Zamzam A, Abularrage C, Wittgen C. Treatment and outcomes of aortic endograft infection. J Vasc Surg 2016; 63:332-40. [DOI: 10.1016/j.jvs.2015.08.113] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
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35
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Takase Y, Kodama K, Motoi I. Successful endovascular treatment using a covered stent for artery-ureteral fistula after surgery for abdominal aortic aneurysm. Indian J Urol 2015; 31:256-8. [PMID: 26166974 PMCID: PMC4495505 DOI: 10.4103/0970-1591.159668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Artery-ureteral fistula (AUF) is a rare condition but there is an increase in the number of reported cases. It is frequently difficult to treat. A 63-year-old male who had undergone a Dacron Y-graft placement for an infrarenal aortic aneurysm 3 years earlier, presented with hematuria. Contrast-enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis. Endovascular treatment using a covered stent was performed successfully.
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Affiliation(s)
- Yasukazu Takase
- Department of Urology, Toyama City Hospital, 2-1 Imaizumihokubu-chou, Toyama, Toyama 939-8511, Japan
| | - Koichi Kodama
- Department of Urology, Toyama City Hospital, 2-1 Imaizumihokubu-chou, Toyama, Toyama 939-8511, Japan
| | - Isamu Motoi
- Department of Urology, Toyama City Hospital, 2-1 Imaizumihokubu-chou, Toyama, Toyama 939-8511, Japan
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36
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Das A, Lewandoski P, Laganosky D, Walton J, Shenot P. Ureteroarterial fistula: A review of the literature. Vascular 2015; 24:203-7. [PMID: 25972027 DOI: 10.1177/1708538115585261] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Akhil Das
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Patricia Lewandoski
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dean Laganosky
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John Walton
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Patrick Shenot
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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37
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Rao AM, Khalil A, Suttie S. A rare cause of massive haematuria: Internal iliac artery-ureteric fistula. Vascular 2014; 23:193-6. [PMID: 24903530 DOI: 10.1177/1708538114538623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ureteric fistula into the arterial tree is a well-recognised, but uncommon condition. The involvement of internal iliac artery is rare. We present a rare case of fistulous communication and subsequent infection of an internal iliac artery aneurysm and ureter secondary to insertion of ureteric stent following endovascular exclusion of the aneurysm and its management. Nephrostogram identified the fistula not seen on computerised tomography. This case highlights the awareness of such pathology allowing for prompt recognition of the condition and importance of appropriate imaging.
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Affiliation(s)
- Ahsan M Rao
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - Ahmed Khalil
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
| | - Stuart Suttie
- Department of Vascular Surgery, Ninewells Hospital, Dundee, UK
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38
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Diagnosis and treatment of arterial-ureteric fistula. J Vasc Surg 2014; 59:1701-4. [DOI: 10.1016/j.jvs.2013.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 05/28/2013] [Accepted: 06/05/2013] [Indexed: 12/27/2022]
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39
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Muradi A, Yamaguchi M, Idoguchi K, Okada T, Nomura Y, Okita Y, Sugimoto K. Lessons learned from endovascular management of ureteroarterial fistula. Vasc Endovascular Surg 2013; 48:159-61. [PMID: 24203347 DOI: 10.1177/1538574413510620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stent graft placement for ureteroarterial fistula is the preferred treatment. However, some pitfalls may occur during the procedure. Chronic inflammation process will induce longer adhesion area between artery and ureter, which results in unusual fistula site and rigid iliac arteries. This further leads to difficulty in advancing the endograft delivery system, even when access route is large enough. Multiple attempts to pass the iliac artery may result in "incidental" mechanical provocative angiography with subsequent massive bleeding. These suggested us not only to be careful and prepared but also to consider that angiography after inserting the delivery system could give additional information on the exact fistula site.
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Affiliation(s)
- Akhmadu Muradi
- 1Center for Endovascular Therapy, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
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40
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Haegeman S, Vaninbroukx J, Heye S, Joniau S, Van Poppel H, Oyen R, Maleux G. Pseudoaneurysm associated with an arteriovesical fistula after bladder substitution surgery definitively treated with a covered stent: a report of 3 cases. Vasc Endovascular Surg 2013; 47:652-5. [PMID: 23970780 DOI: 10.1177/1538574413500724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A fistula between the iliac artery and a bladder pouch is a rare but potentially life-threatening condition. In 3 patients presenting with massive hematuria after urinary diversion, an iliac artery pseudoaneurysm was found on imaging studies. These pseudoaneurysms were considered to be associated with a fistula between artery and pouch, causing the hematuria. All patients were successfully treated with a covered stent to exclude the pseudoaneurysm and the arteriovesical fistula. Clinical follow-up of 10 weeks, 16 months, and 27 months, respectively, showed no residual hematuria. In addition, no clinical signs of stent graft infection or thrombosis were identified during follow-up. In conclusion, the placement of a covered stent is a valuable therapeutic treatment option in the management of hematuria due to an arteriovesical fistula after urinary diversion surgery.
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Affiliation(s)
- Steven Haegeman
- 1Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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41
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A primary arterial-ureteral fistula after an aortic-bifemoral bypass. Int J Surg Case Rep 2012; 4:48-50. [PMID: 23123414 DOI: 10.1016/j.ijscr.2012.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/28/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Primary arterial-ureteral fistula is a rare and diagnostically challenging condition which may present with massive hematuria. PRESENTATION OF CASE A case of primary arterial-ureteral fistula (AUF) is presented in a patient with a previous prosthetic aortic-bifemoral bypass. The AUF treated with arterial and ureteral resection, arterial ligation and ureteral reconstruction. DISCUSSION Primary AUF are more frequently associated with aneurysmal degeneration of the arterial wall. The development of a primary fistula due to an iliac artery aneurysm many years after an aortic-bifemoral bypass performed due to atherosclerotic obstructive disease is a very unusual presentation of this entity. Multiple surgical strategies can be employed in achieving hemorrhage and infection control, urinary tract continuity, and vascular reconstruction. CONCLUSION A multidisciplinary approach and the achievement of a pre-operative diagnosis are essential for an effective management of this condition with prognostic implications.
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