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Prontera PP, Sciorio C, De Cillis A, Martinelli E, Schiralli F, Lattarulo M, D'Elia A, Utano E, Grossi FS. Early diagnosis and management of arterio-ureteral fistulas: A literature review. Arch Ital Urol Androl 2023; 95:10928. [PMID: 36924382 DOI: 10.4081/aiua.2023.10928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology. MATERIALS AND METHODS A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers. RESULTS A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice. CONCLUSIONS Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.
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Affiliation(s)
| | - Carmine Sciorio
- Department of Urology, "Alessandro Manzoni" Hospital, Lecco.
| | | | | | | | | | - Angelo D'Elia
- Department of Urology, "S.S. Annunziata" Hospital, Taranto.
| | - Emanuele Utano
- Department of Urology, "S.S. Annunziata" Hospital, Taranto.
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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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Ebata Y, Morisaki K, Matsubara Y, Kurose S, Yoshino S, Nakayama K, Kawakubo E, Furuyama T, Mori M. A systematic review of management of uretero-arterial fistula. J Vasc Surg 2022; 76:1417-1423.e5. [PMID: 35709856 DOI: 10.1016/j.jvs.2022.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/27/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Uretero-arterial fistula (UAF) is lethal condition. However, there is no consensus regarding diagnosis and treatment of UAF owing to its rarity. The aim of this paper was to present an actual case of UAF and to systematically review the symptoms, risk factors, diagnosis, and treatment of this condition. METHODS The case study included a 52-year-old woman who showed a massive hemorrhage during urinary stent replacement. For the systematic review of articles on UAF, those written in English and published from 1939 to 2020 were searched on PubMed using the keywords "uretero-arterial fistula," "arterio-ureteral fistula," and "hematuria". RESULTS We included 121 articles and 235 patients (mean age, 66.0 years; women, 139 [59.1%]) in this review. UAF occurred most frequently in the common iliac artery (112 patients [47.7%]). Almost all patients (232 patients [98.7 %]) complained of hematuria. The risk factors for UAF were pelvic surgery (205 patients [87.2%]), long-term use of urinary stents (170 patients [72.3%]), oncologic radiotherapy (107 patients [45.5%]), and malignancy (159 patients [67.7%]). Although computed tomography (CT) can detect various useful findings such as extravasation, pseudoaneurysm, hydronephrosis, and opacification of ureters, it was diagnostically useful in only one-third of the cases. Angiography was useful in diagnosing UAF in 124 (66.3%) of the 187 patients (80.0%) who underwent this procedure. With regard to treatment, endovascular approaches have been widely used in recent years because their invasiveness is lesser than that of open surgical repair. In the era of endovascular therapy, the indications for open surgical repair include ureteral-intestinal fistula, abscess formation, and graft infection after endovascular therapy. CONCLUSIONS CT was recommended as the first examination in patients with risk factors for UAF because of its usefulness. Subsequently, angiography should be considered because UAF can be treated using an endovascular approach following diagnostic angiography. Diagnosis and treatment of UAF can often be difficult; therefore, the important first step of diagnosis is suspecting UAF and employing a multidisciplinary approach.
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Affiliation(s)
- Yuho Ebata
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yutaka Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shun Kurose
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Yoshino
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Nakayama
- Department of Vascular Surgery, Beppu Medical Center, Oita, Japan
| | - Eisuke Kawakubo
- Department of Vascular Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Tadashi Furuyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Dean, Tokai University School of Medicine, Kanagawa, Japan
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McSweeney A, Tarpara A, Salvatore D, DiMuzio P, Nooromid M, Abai B. Coil embolization of ruptured distal renal artery pseudoaneurysm with gross hematuria and hemorrhagic shock. J Vasc Surg Cases Innov Tech 2022; 8:210-213. [PMID: 35493341 PMCID: PMC9048051 DOI: 10.1016/j.jvscit.2022.03.005] [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: 10/25/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Renal artery pseudoaneurysms have been infrequently reported in the literature. In the present report, we have described a case of a ruptured renal artery pseudoaneurysm requiring coil embolization. A 49-year-old man had presented to our institution with a hypertensive emergency. Computed tomography revealed a 3.4-cm right renal artery pseudoaneurysm. Nonemergent coil embolization was planned for the following day. However, he became hypotensive, exsanguinating frank blood from the urethra. An arteriogram showed extravasation of contrast into the pseudoaneurysm sac, renal pelvis, and ureter, consistent with intrarenal pseudoaneurysm rupture. We have demonstrated coil embolization as a method of repairing a ruptured renal artery pseudoaneurysm with gross hematuria.
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Abou Chakra M, Azoulai D, Peyromaure M, Barry Delongchamps N, Bailly H, Lucas A, Dautry R, Duquesne I. A Challenging Case of Ureteroiliac Artery Fistula Managed With an Endovascular Approach. Vasc Endovascular Surg 2022; 56:15385744221105817. [PMID: 35613948 DOI: 10.1177/15385744221105817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ureteroarterial fistula (UAF) is a rare but life-threatening condition because of massive hemorrhage. Risk factors include degenerative vascular diseases, previous vascular surgery, pelvic radiation, chemotherapy, pelvic surgery, and prolonged ureteral stenting. The most common presentation of UAF is massive hematuria with hemorrhagic shock. The diagnosis is always difficult even with angiography. Endovascular repair with stenting and/or coiling is effective and safe. The surgical treatment should be used in recurrent UAF cases. We reported a rare case describing rapid management of a UAF in a patient who presented with hematuria even when we had no diagnosis on the initial CT scan. The patient was in shock. Deployment of a stent graft within the common iliac artery bypassing the UAF was performed. The patient improved rapidly.
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Affiliation(s)
- Mohamad Abou Chakra
- Faculty of Medicine, Urology Department, 63572Lebanese University, Beirut, Lebanon
| | - David Azoulai
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
| | - Michael Peyromaure
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
| | - Nicolas Barry Delongchamps
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
| | - Hugo Bailly
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
| | - Alexandre Lucas
- Department of Diagnostic and Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
| | - Raphaël Dautry
- Department of Diagnostic and Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
| | - Igor Duquesne
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 26935Cochin Hospital, Paris, France
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Lock TMTW, Kamphorst K, van den Bergh RCN, Moll FL, de Vries JPPM, Lo RTH, de Kort GAP, Bruijnen RCG, Dik P, Horenblas S, de Kort LMO. Arterio-ureteral fistula: a nationwide cross-sectional questionnaire analysis. World J Urol 2022; 40:831-839. [PMID: 35064800 PMCID: PMC8783176 DOI: 10.1007/s00345-021-03910-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists’ experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice. Methods A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used. Results Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention. Conclusion The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03910-3.
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Affiliation(s)
- Tycho M T W Lock
- Department of Urology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands.
| | - Kyara Kamphorst
- Department of Urology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | | | - Frans L Moll
- Division of Vascular Surgery, Department of Surgery, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Jean-Paul P M de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rob T H Lo
- Department of Interventional Radiology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Gérard A P de Kort
- Department of Interventional Radiology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Department of Interventional Radiology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Pieter Dik
- Department of Pediatric Urology, Wilhelmina Children's Hospital UMC Utrecht, Utrecht, The Netherlands.,Division of Pediatric Urology and Andrology, Department of Pediatric Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Laetitia M O de Kort
- Department of Urology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
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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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8
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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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10
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Ureteroiliac fistula as a JJ catheter placement complication. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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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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Yoshioka N, Takagi K, Morita Y, Kawase M, Morishima I. Endovascular treatment of arterio-ureteral fistula with new-generation balloon-expandable stent graft using a 7-French system. SAGE Open Med Case Rep 2020; 8:2050313X20959219. [PMID: 33062280 PMCID: PMC7534066 DOI: 10.1177/2050313x20959219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022] Open
Abstract
Arterio-ureteral fistulas are relatively rare, but a potentially life-threatening condition because of the possible massive bleeding. An 82-year-old woman with a history of hysterectomy and irradiation for uterine cancer was treated with ureteric stents for recurrent bilateral ureteral stenosis. During the adjustments of the stent, removing the right ureteric stent immediately resulted in massive hematuria. Computed tomography showed that the right ureter coursed above and seemed to be connected to the right external iliac artery. From the clinical history and computed tomography findings, an arterio-ureteral fistula between the right external iliac artery and right ureter was strongly suspected. The GORE® VIABAHN® VBX Stent Graft was deployed from the common iliac artery to the external iliac artery via a 7-French femoral system, followed by post-dilatation. The patient did not develop any complications or recurrence of hematuria after the procedure during the 11-month follow-up. The VBX is a useful device, with a low- profile device and a size-adjustable balloon-expandable stent that depended on the individual vessel size for post-dilatation. However, there are several concerns, such as risk of infection, stent thrombosis/stenosis, and chronic outcome while using stent grafts for treatment. Patients with arterio-ureteral fistulas who were treated using stent grafts should be carefully followed up.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Makoto Kawase
- Department of Urology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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Perrenoud AL, Heiberger G, Shriver J, Yim D. Endoleak and Pseudoaneurysm Formation in the Setting of Stent Graft Infection Following Endovascular Uretero-Arterial Fistula Repair: The Dreaded Complication. Cureus 2020; 12:e8830. [PMID: 32742842 PMCID: PMC7384727 DOI: 10.7759/cureus.8830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The complication of uretero-arterial fistula after prolong ureteral stenting is well recognized. The treatment is primarily endovascular stenting across the fistulous communication accepting the potential risk of stent graft infection. Herein we present a case of a 71-year-old female who developed an uretero-arterial fistula after prolong ureteral stenting and exchanges following ileal conduit obstruction. Initial treatment with left common iliac stenting controlled the hematuria, but only temporarily. Repeat angiography revealed a type 1b endoleak requiring stent extension. Unfortunately, persistent hematuria necessitating further angiography showed the development of a saccular pseudoaneurysm around the stent graft requiring proximal stent extension. A nuclear medicine indium 111-tagged white blood cell scan with single-photon emission CT (SPECT)/CT confirmed stent graft infection. Conservative therapy with antibiotics failed, causing graft failure that ultimately required bypass surgery.
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Affiliation(s)
- Abby L Perrenoud
- Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Garret Heiberger
- Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Jackson Shriver
- Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Douglas Yim
- Interventional Radiology, Avera McKennan Hospital and University Health Center, Sioux Falls, USA.,Medicine/Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
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14
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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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