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Awad A, Abou Shaar B, Zvavanjanja RC. Silent arterio-ureteral fistula: Diagnosis and endovascular management. Urol Case Rep 2024; 54:102712. [PMID: 38623493 PMCID: PMC11016575 DOI: 10.1016/j.eucr.2024.102712] [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: 02/18/2024] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
We report a patient with history of recurrent invasive rectal adenocarcinoma complicated by obstructive uropathy requiring nephro-ureteral catheter placement. Two years later during a regular catheter exchange, the patient developed unusually bloody urine raising suspicion for possible vascular injury. CT angiogram and conventional angiogram were negative. However, an antegrade nephrostogram revealed a fistulous communication between the right ureter and the right internal iliac artery. Subsequently, the artery was sacrificed using detachable coils. We discuss the rare encounter of a silent arterio-ureteral fistula, the value of antegrade nephrostogram as a diagnostic tool, and the management options in such scenario.
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Affiliation(s)
- Ahmed Awad
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA 77030
| | | | - Rodrick c. Zvavanjanja
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, TX, USA 77030
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2
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Sistla L, Frahm-Jensen G. Successful, staged management of an iliac artery to ileal urinary conduit fistula. J Vasc Surg Cases Innov Tech 2023; 9:101331. [PMID: 38106345 PMCID: PMC10725069 DOI: 10.1016/j.jvscit.2023.101331] [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: 03/15/2023] [Accepted: 09/05/2023] [Indexed: 12/19/2023] Open
Abstract
Fistula formation between the iliac artery and an ileal conduit is a rare pathology. A 39-year-old female patient presented with intermittent hematuria from her ileal conduit for 4 days, which progressed to massive hemorrhage on the ward. Her background includes stage 4A squamous cell carcinoma of the cervix treated with pelvic chemoradiotherapy and brachytherapy, recurrent obstructive uropathy requiring bilateral nephrostomies and bilateral ureteral stenting. Twelve months before this presentation, she had been treated for an iliac artery-ileal conduit fistula with a covered stent to the left common iliac artery. After initial fluid resuscitation, the bleeding was managed with endovascular placement of a covered stent. She subsequently underwent definitive vascular reconstruction with removal of the common iliac artery stents, an aortoiliac bypass using a vein graft, and repair of the ileal conduit electively. This case demonstrates the management of a rare clinical pathology and highlights the importance of close surveillance after endovascular procedures.
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Affiliation(s)
- Laxmi Sistla
- Division of Vascular Surgery, Department of Surgery, Canberra Hospital, Garran, ACT, Australia
| | - Gert Frahm-Jensen
- Division of Vascular Surgery, Department of Surgery, Canberra Hospital, Garran, ACT, Australia
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3
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Ongaro L, Rizzo M, Claps F, Runti O, Piasentin A, Trombetta C, Liguori G. Arterioureteral fistula: An unusual cause of haematuria 10 years after the implantation of a synthetic iliac-femoral stent. Asian J Urol 2023; 10:563-564. [PMID: 38024425 PMCID: PMC10659961 DOI: 10.1016/j.ajur.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Luca Ongaro
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Michele Rizzo
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Ottavia Runti
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Andrea Piasentin
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Carlo Trombetta
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
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4
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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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5
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Kajaia D, Hager B, Heidorn T, Schneider H, Weingärtner K, Zugor V. [Uretero-iliac artery fistula as a urological emergency]. Aktuelle Urol 2023; 54:44-49. [PMID: 33212519 DOI: 10.1055/a-1180-0191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Uretero-iliac artery fistulae represent a urological emergency with considerable mortality. We present 2 cases of a uretero-iliac artery fistula. Nowadays, minimally-invasive endovascular therapy seems to be the treatment of choice. For an optimal outcome, a multidisciplinary team with imminent availability of radiology, vascular surgery, urology and anaesthesia is required.
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Affiliation(s)
- David Kajaia
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Benjamin Hager
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Timm Heidorn
- Sozialstiftung Bamberg, Klinik für Diagnostische Radiologie, Interventionelle Radiologie und Neuroradiologie, Bamberg
| | - Hans Schneider
- Sozialstiftung Bamberg, Klinik für Diagnostische Radiologie, Interventionelle Radiologie und Neuroradiologie, Bamberg
| | - Karl Weingärtner
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
| | - Vahudin Zugor
- Sozialstiftung Bamberg, Klinik für Urologie, Kinderurologie und roboterassistierte minimalinvasive Urologie, Bamberg
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Mearini E, Paladini A, Cellini V, Mearini M, Felici G, Vitale A, Cochetti G. Ureteroiliac fistula after oncological surgery: Case report and review of the literature. Open Med (Wars) 2022; 17:2013-2020. [PMID: 36568516 PMCID: PMC9746699 DOI: 10.1515/med-2022-0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/02/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022] Open
Abstract
Fistulas arising between ureters and iliac arteries (UAF) are rare pathological events and frequently require emergency treatment, as they are associated with massive haematuria and haemorrhagic shock. The medical history plays a key role in the diagnostic and therapeutic process, as it allows to include UAF among the differential diagnoses of gross haematuria. The emergency treatments of fistulas arising between the urinary system and the vascular system include the open repairing surgery or the endovascular grafting, the latter generally better tolerated by patients suffering from multiple comorbidities or not eligible for traditional surgery. Nephrostomy or ureteral stent can be used to drain the affected upper urinary tract temporarily or permanently. Herein, we reported two cases of oncological patients affected by UAF and treated successfully by endovascular procedures. Furthermore, we performed a narrative review of the literature concerning UAF and its diagnostic and therapeutic management. Although our study did not allow us to state definitive conclusion about the diagnostic and therapeutic management of UAF due to small sample size, our findings support previous experiences in favour of the treatment of fistulas with an endovascular approach.
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Affiliation(s)
- Ettore Mearini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Alessio Paladini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Valerio Cellini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Matteo Mearini
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Graziano Felici
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Andrea Vitale
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
| | - Giovanni Cochetti
- Department of Medicine and Surgery, Division of Urology, University of Perugia, Perugia, 06129, Italy
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7
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El Youbi S, Landry JL, Uzarciuc G. Endovascular management of uretero-Iliac artery fistula. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:256-258. [PMID: 36464421 DOI: 10.1016/j.jdmv.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Uretero-Iliac artery fistula (UIAF) is a rare condition in vascular surgery, its prognosis remains poor with a high mortality, requires rapid multidisciplinary diagnosis and treatment. We report the case of an uretero-Iliac artery fistula in a 65-year-old patient who underwent total pelvectomy with trans-ileal cutaneous ureterostomy (Bricker), followed by pelvic radiotherapy, and placement of a single J ureteral stent, diagnosed by abdominal and pelvic CT, and treated by endovascular approach.
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Affiliation(s)
- S El Youbi
- Vascular Surgery Department, Alpes Leman hospital center, Contamine-sur-Arve, France.
| | - J-L Landry
- Department of Urology, Alpes Leman hospital center, Contamine-sur-Arve, France
| | - G Uzarciuc
- Vascular Surgery Department, Alpes Leman hospital center, Contamine-sur-Arve, France
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8
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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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9
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Jiang Z, Wang J, Cui J, Chen S, Qu S, Wang W, Guo H, Shi B, Zhu Y. Arterioureteral fistula after radical cystectomy and ureterocutaneostomy: two case reports and a systematic literature review. BMC Urol 2022; 22:117. [PMID: 35897095 PMCID: PMC9330645 DOI: 10.1186/s12894-022-01071-y] [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: 03/08/2022] [Accepted: 07/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Arterioureteral fistula (AUF) is a rare, life-threatening condition wherein communication occurs between a ureter and the common, internal, or external iliac artery. The sensitivity of common clinical imaging examination for AUF is low, which leads to a delayed diagnosis and increased mortality. In addition, the increased use of ureteral stents contributes to the growing frequency of AUF. Case presentation Our two patients were 74 and 65 years old males respectively. They both had a medical history of bladder cancer and underwent radical cystectomy with ureterocutaneostomy. The patients underwent routine catheter exchange during over 1 year postradical cystectomy and subsequently experienced intermittent gross pulsatile haematuria. After a series of imaging examinations failed to identify the cause, the patients were ultimately diagnosed with AUF and treated with interventional radiotherapy, followed by broad-spectrum antibiotics. Positive effects were found. Conclusions The incidence of AUF is increased with the prolongation of survival in patients with related risk factors. This case report aims to highlight early diagnosis and management of AUF to lower the mortality.
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Affiliation(s)
- Zhiwen Jiang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Jian Wang
- Department of Urology, People's Hospital of Laoling, Laoling, Shandong Province, People's Republic of China
| | - Jianfeng Cui
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Shouzhen Chen
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Sifeng Qu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Wenfu Wang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Hu Guo
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong Province, People's Republic of China.
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10
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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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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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12
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Chen JJ, Wang J, Zheng QG, Sun ZH, Li JC, Xu ZL, Huang XJ. Uretero-lumbar artery fistula: A case report. World J Clin Cases 2021; 9:10013-10017. [PMID: 34877344 PMCID: PMC8610900 DOI: 10.12998/wjcc.v9.i32.10013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/29/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Uretero-arterial fistula (UAF) is a disease that usually involves the aorta, common iliac artery, external iliac artery, hypogastric artery, and lumbar artery. Among them, uretero-lumbar artery fistula (ULAF) is the most unusual type. So, both in China and around the world, the diagnosis and treatment of ULAF is a big challenge.
CASE SUMMARY A 55-year-old female patient with a history of pelvic radiotherapy developed unexplained massive hemorrhage during replacement of the right Resonance metallic ureteral double-J tubes due to a long-standing indwelling ureteral stent for ureteral stricture. Later, we found contrast extravasation from the patient's right L4 artery into the ureter under digital subtraction angiography (DSA) and administered polyvinyl alcohol particle embolic agent and coil embolization; hematuria was controlled. Follow-up investigations at 18 mo showed no sign of recurrence.
CONCLUSION DSA is very important in the diagnosis and treatment of UAF, and DSA should be preferred when UAF is suspected. In addition, the use of softer ureteral stents in patients with primary disease and risk factors for UAF should be considered to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.
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Affiliation(s)
- Jia-Jian Chen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jian Wang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Qi-Gang Zheng
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhao-Hui Sun
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jia-Cheng Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zi-Lei Xu
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xiao-Jun Huang
- Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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13
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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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14
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Asynchronous Bilateral Ureteric-Arterial Fistula: Diagnosis and Treatment. Case Rep Urol 2021; 2021:5590432. [PMID: 34007508 PMCID: PMC8110400 DOI: 10.1155/2021/5590432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022] Open
Abstract
A 48-year-old woman submitted to anterior exenteration plus ileal-cutaneous conduit for metastatic cervical cancer during the change of the ureteral stent showed massive bleeding in the left ureter. A selective intra-arterial angiography showed a fistula between the ureter and the left common iliac artery that the interventional radiologist quickly repaired by inserting a vascular endoprosthesis. Six months later, gross hematuria secondary to right ureter-iliac fistula occurred again and a second endoprosthesis was inserted. Asynchronous bilateral ureteric stent-related vascular fistula is an uncommon scenario, but it should be suspected in the presence of hematuria following ureteral stent replacement.
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15
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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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16
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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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17
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Sachsamanis G, Pfister K, Kasprzak PM, Schierling W, Denzinger S, Oikonomou K. Midterm Results after Open Surgical and Endovascular Management of Arterioureteral Fistula. Ann Vasc Surg 2020; 73:280-289. [PMID: 33359692 DOI: 10.1016/j.avsg.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. METHODS We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up. RESULTS Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery. DISCUSSION Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Karin Pfister
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Piotr M Kasprzak
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas-Hospital Saint Josef Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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18
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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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19
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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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20
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Berastegi-Santamaria C, Echevarria-Uraga JJ, Garcia-Garai N, Jiménez-Zapater C, Cura-Allende GD. Ureteroarterial fistula treated by endovascular stent placement. Radiol Case Rep 2020; 15:1714-1717. [PMID: 32742534 PMCID: PMC7385041 DOI: 10.1016/j.radcr.2020.05.044] [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] [Received: 05/03/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 10/28/2022] Open
Abstract
A 69-year-old woman with changes secondary to pelvic radiotherapy presents repeated episodes of massive hematuria associated with double J catheter replacements. After several imaging tests, an uretero-arterial fistula is confirmed by angiography and treated with a coated stent. Uretero-arterial fistula poses a diagnostic challenge, requiring a multidisciplinary approach through clinical suspicion and interventional procedures.
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Affiliation(s)
- Cristina Berastegi-Santamaria
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Department of Radiology, Labeaga s/n, Galdakao, 48960 Galdakao, Spain
| | - José Javier Echevarria-Uraga
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Department of Radiology, Labeaga s/n, Galdakao, 48960 Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903 Barakaldo, Spain
| | - Nerea Garcia-Garai
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Department of Radiology, Labeaga s/n, Galdakao, 48960 Galdakao, Spain
| | - Carlos Jiménez-Zapater
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Department of Radiology, Labeaga s/n, Galdakao, 48960 Galdakao, Spain
| | - Gorka Del Cura-Allende
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Department of Radiology, Labeaga s/n, Galdakao, 48960 Galdakao, Spain.,Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903 Barakaldo, Spain
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21
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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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Sekito S, Onishi T, Terabe T, Shibahara T. Successful management of a fistula between an external iliac artery and an ileal conduit with endovascular embolization and vascular bypass. IJU Case Rep 2020; 3:5-7. [PMID: 32743454 PMCID: PMC7292179 DOI: 10.1002/iju5.12123] [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] [Received: 06/03/2019] [Accepted: 09/19/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Fistula formation between an ileac artery and an ileal conduit after radical cystectomy is a rare complication. CASE PRESENTATION A 72-year-old woman underwent laparoscopic radical cystectomy with ileal conduit. After surgery, leakage of ileal-ureteral anastomosis with infection was observed. Five months after surgery, sudden bleeding from the ileal conduit occurred that stopped spontaneously. Contrast-enhanced computed tomography suggested a pseudo aneurysm of the right external iliac artery in contact with the ileal conduit. A fistula between the artery and ileal conduit was suspected. She underwent embolization of the common iliac artery and femorofemoral bypass. She had a good clinical course and no sign of hematuria over 6 months of follow-up. CONCLUSION An episode of warning hemorrhage from the urostomy is an important sign of fistula, and endovascular treatment is a feasible approach to treat this condition.
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Affiliation(s)
- Sho Sekito
- Department of UrologyIse Red Cross HospitalIseMieJapan
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23
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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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24
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Titomihelakis G, Feghali A, Nguyen T, Salvatore D, DiMuzio P, Abai B. Endovascular management and the risk of late failure in the treatment of ureteroarterial fistulas. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:396-401. [PMID: 31660458 PMCID: PMC6806659 DOI: 10.1016/j.jvscit.2019.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Abstract
Ureteroarterial fistula (UAF) is a rare and life-threatening source of hematuria. A high index of suspicion is warranted for early diagnosis and timely intervention. Because of high perioperative risk and comorbidities in UAF patients, the endovascular approach has become preferred for repair. Infection can complicate this mode of therapy, and treatment with antibiotics is important. Herein we present five cases of secondary UAFs treated with stent graft alone or stent graft and embolization.
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Affiliation(s)
- George Titomihelakis
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Anthony Feghali
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Tuong Nguyen
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Dawn Salvatore
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Paul DiMuzio
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Babak Abai
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
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25
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Crane A, Rizzo A, Gong M, Sivalingam S. Ureteroarterial Fistula in a Patient with an Ileal Conduit and Chronic Nephroureteral Catheter. J Endourol Case Rep 2019; 5:64-67. [PMID: 32760803 DOI: 10.1089/cren.2019.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Ureteroarterial fistula (UAF) is a rare and potentially devastating diagnosis most often associated with a combination of pelvic oncologic or vascular surgery, radiation, and chronic ureteral stents. Herein we discuss a patient with an ileal conduit urinary diversion and left nephroureteral (NU) catheter who presented with gross hematuria and hemodynamic instability. He underwent multiple negative radiologic investigations and his clinical course highlights the need for a high index of suspicion for UAF and multidisciplinary coordination with vascular surgery and interventional radiology. Case Presentation: Our patient is a 64-year-old male with a history of bladder cancer and atrial fibrillation on rivaroxiban who underwent cystoprostatectomy with ileal conduit urinary diversion. His postoperative course was complicated by subsequent mid-distal stricture of his left ureter, which was managed with balloon dilatation and a chronic indwelling NU catheter. He underwent a routine catheter exchange ∼1 year postradical cystectomy and subsequently experienced intermittent gross hematuria. He presented 5 weeks later with profound hematuria and clots through his urostomy accompanied by flank pain, weakness, and tachycardia. Throughout his hospital course he underwent two CT angiograms and a formal provocative angiogram that were all negative. He was taken to the operating room (OR) for attempted antegrade ureteroscopy, which was aborted because of pulsatile bleeding observed upon withdrawal of his stent. In collaboration with vascular surgery, he was eventually taken for provocative angiogram and covered stent graft placement that resolved the hematuria. Conclusion: This case highlights the diagnostic and care coordination challenges in patients with UAF. A high suspicion should be maintained in patients with hematuria and indwelling stents with a history of pelvic surgery and/or radiation.
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Affiliation(s)
- Alice Crane
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anthony Rizzo
- Vascular Surgery Department, Cleveland Clinic, Cleveland, Ohio
| | - Michael Gong
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sri Sivalingam
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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26
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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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