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A: Aortography shows a right common iliac artery aneurysm, left femoral artery aneurysm, and patent femorofemoral bypass graft. B: Enhanced computed tomography scan demonstrates a 5 × 5 cm right common iliac artery aneurysm and right ureter adhered to the aneurysm (arrow).
Source publication
We describe a case of successful surgical treatment for spontaneous rupture of an iliac artery aneurysm into a ureter. An 80-year-old man was admitted with massive hematuria. Immediate enhanced abdominal computed tomography scan and cystoscopy were suspicious for a uretero-arterial fistula caused by aneurysmal rupture. Emergent surgical interventio...
Contexts in source publication
Context 1
... admission, aortography indicated an aneurysm of the right IIA aneurysm with obstruction of the right EIA, femorofemoral bypass graft, and left femoral arterial (FA) aneurysm (Fig. 1A). He was noted to have hemodynamic shock and severe anemia. Immediate enhanced CT demonstrated a 5 × 5 cm right IIA aneurysm and right ureter adhered to the aneurysm (Fig. 1B). Cystoscopy showed blood clots in the right ureteral orifice but no obvious bleeding in the bladder. We diagnosed the ruptured aneurysm of the right IIA into the ...
Context 2
... admission, aortography indicated an aneurysm of the right IIA aneurysm with obstruction of the right EIA, femorofemoral bypass graft, and left femoral arterial (FA) aneurysm (Fig. 1A). He was noted to have hemodynamic shock and severe anemia. Immediate enhanced CT demonstrated a 5 × 5 cm right IIA aneurysm and right ureter adhered to the aneurysm (Fig. 1B). Cystoscopy showed blood clots in the right ureteral orifice but no obvious bleeding in the bladder. We diagnosed the ruptured aneurysm of the right IIA into the ureter, and performed emergent ...
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Objectives:
This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients.
Methods:
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Citations
... Ureter repair is performed by reimplanting the ureter away from the vessels or by placing a nephrostomy tube. If the kidney is atrophic, nephrectomy and ureterectomy are performed [48]. ...
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.
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.
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 con-ducted. 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 diag-nostic 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 identi-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.
Uretero-arterial fistula (UAF) is a rare complication of either aneurysmal disease primarily or pelvic inflammation secondary to urologic, oncologic, or vascular interventions. Diagnosis can be difficult to confirm and treatment may need to proceed on high index of suspicion alone. We present the case of a 56-year-old woman suffering from intermittent hematuria after laser lithotripsy leading to UAF between her left ureter and left Dacron aortobifemoral bypass limb. The fistula was successfully treated with endovascular intervention.
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.
Arterio-ureteral fistula (AUF) is a rare, but life-threatening disease that causes massive hematuria. We present a case of a 43-year-old female with AUF successfully treated with coil embolization and deployment of endovascular stents, along with a literature review. AUF symptoms most commonly occur with intermittent hematuria. AUF can occur in association with ureteral stenting, radiation, and prior pelvic or vascular surgery. Arteriography or ureteral pyelography are recommended as the most effective diagnostic strategies. Recent treatment efforts have focused on the use of endovascular stenting techniques as an alternative to open surgery.
Solitary Iliac Aneurysms (SIAs) are rare and difficult to find because of the asymptomatic natural history. Therefore, they have a significant risk of rupture with high mortality and morbidity. We report a case of successful surgical repair for ruptured SIA coexisting hydronephrosis. A 78-year-old male was addressed in a state of shock to our hospital for lower abdominal pain. CT scan demonstrated right giant SIA rupture into peritoneal cavity complicated by hydronephrosis. Emergent surgery was done by laparotomy in which Y-graft replacement was performed remaining the ureter untouched. Postoperative course was uneventful and hydronephrosis disappeared 6 months after the surgery.
Background
Ureteroarterial fistulas (UAFs) have a low incidence but are a potentially fatal cause of hematuria. Initially treated by open surgery, endovascular techniques have decreased potential complications.
Material and Methods
We present a short series of UAFs (n = 5) treated in our institution in the last 10 years: 1 case showed up after aorta-iliac bypass surgery, 1 case after endovascular aortic repair and embolization of right hypogastric artery, and 3 cases after oncological surgeries. We review the published literature via PubMed.
Results
The different approaches (2 open and 3 endovascular procedures) were based on the clinical situation of the patients and on technical limitations. Three patients died after the procedure (2 after open surgery and 1 after endovascular treatment). In our institution, endovascular treatment showed good results in terms of early complications and associated mortality compared with open surgery.
Conclusions
UAF is a rare but a potentially fatal complication in patients with predisposing factors. No long-term follow-up has been published to assess the possible complications arising from the technique, such as prosthetic infection. No antibiotic treatment protocols have been established, so long-term follow-up is necessary to determine late complications.
Eine massive Blutung aus dem Urogenitaltrakt ist, wie aus allen anderen Organen, ein medizinischer Notfall und macht die schnelle, aber präzise Diagnosestellung und Therapie erforderlich. Dieses Thema wird im Folgenden in 4 Hauptkategorien behandelt: Zunächst werden die entzündlichen Ursachen diskutiert, gefolgt von interventions-, traumatisch- und neoplastisch bedingten Ursachen. Abschließend werden die selteneren, aber klinisch relevanten Ursachen erörtert.
