Diagnosis and management of ureteroiliac artery fistula: value of provocative arteriography followed by common iliac artery embolization and extraanatomic arterial bypass grafting.
OBJECTIVE
We describe an effective multidisciplinary approach to the diagnosis and management of ureteroarterial fistulas that reduces morbidity and mortality.


METHODS
Five ureteroarterial fistulas in 4 patients were studied with standard and provocative arteriography (arteriography combined with ureteral manipulation). After establishing the diagnosis, each lesion was treated with percutaneous embolic occlusion of the common iliac artery followed by extraanatomic arterial bypass grafting. All patients had chronic ureteral stenting, prior pelvic irradiation, prior pelvic surgery and intrapelvic malignancy, and all fistulas presented with urinary tract hemorrhage.


RESULTS
Standard arteriography was nondiagnostic but provocative arteriography demonstrated the fistula in each case. Successful embolization of the common iliac artery followed by extraanatomic arterial bypass grafting precluded the need for laparotomy and preserved ipsilateral renal function.


CONCLUSIONS
Provocative arteriography followed by arteriographic common iliac artery embolization and extraanatomic bypass grafting was successful for the diagnosis and treatment of ureteroarterial fistulas. There was no mortality, limb loss or renal loss.
Vandersteen
D R
DR
Division of Urology, Oregon Health Sciences University, Portland, USA.
Saxon
R R
RR
Fuchs
E
E
Keller
F S
FS
Taylor
L M
LM
Barry
J M
JM
D000328:Adult; D000368:Aged; D000465:Algorithms; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D005263:Femoral Artery / Q000637:transplantation; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011859:Radiography; D014515:Ureteral Diseases / Q000000981:diagnostic imaging* / Q000628:therapy*; D014548:Urinary Fistula / Q000000981:diagnostic imaging* / Q000628:therapy*