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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