Treatment of Ureteroarterial Fistulae with Covered Vascular Endoprostheses and Ureteral Occlusion

Journal Article · Fri Apr 15 04:00:00 EDT 2005 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-004-0196-0· OSTI ID:21088145

Cosin, Octavio; Bastarrika, Gorka ^[1]; Rosell, David; Zudaire, Javier ^[2]; Martinez-Cuesta, Antonio ^[1]

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1. Clinica Universitaria de Navarra, Universidad de Navarra, Department of Radiology (Spain)
2. Clinica Universitaria de Navarra, Universidad de Navarra, Department of Urology (Spain)

Background. Ureteroarterial fistulae (UAFs) are a rare entity, often difficult to identify, and associated with a high mortality rate. This fact has been attributed to a delay in diagnosis and treatment. Five conditions that can predispose to the development of this uncommon entity have been described: prior pelvic surgery, prolonged ureteral stenting, radiation therapy, previous vascular surgery and vascular pathology. Methods. We present 4 patients with UAFs and at least three of the above-mentioned conditions. Ureteral ischemia and subsequent necrosis promote the formation of these fistulae. The constant pulsation of the iliac artery is transmitted to an already compromised ureter containing a stiff intraluminal foreign body, resulting in pressure necrosis, most likely where the ureter crosses the iliac artery. Results and Conclusion. Cases were managed percutaneously with a combination of the deployment of a covered prosthesis and, when needed, with mechanical occlusion of the ureter. Hematuria stopped in all the patients with no evidence of immediate rebleeding. One patient presented a new episode of vaginal bleeding 13 months after endograft placement and ureteral embolization. Arteriography showed the presence of a hypogastric artery pseudoaneurysm that was occluded using coils. No new bleeding has occurred in this patient 12 months after the second embolization. At present all 4 patients are alive with follow-up periods of 5, 9, 11 and 25 months since the first procedure.

• OSTI ID: 21088145
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 2 Vol. 28; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIES
DIAGNOSIS
FISTULAE
ISCHEMIA
MORTALITY
NECROSIS
PATHOLOGY
PATIENTS
RADIOTHERAPY
SURGERY
URETERS