Endovascular management of ureteral-iliac artery fistulae with Wallgraft endoprostheses.
BACKGROUND
Ureteral-iliac artery fistulae are rare, yet potentially life-threatening, causes of hematuria. Treatment has traditionally been surgical, but advances in endovascular technology have led to a few recent reports of therapy with covered stents. We report two cases of patients diagnosed with ureteral-iliac artery fistulae who were treated with Wallgraft endoprostheses, a new, commercially available covered stent.


METHODS
We report two patients with gynecologic malignancies who presented with massive hematuria and hypotension and were subsequently proven to have ureteral-iliac arterial fistulae. Both patients had prior pelvic surgery, radiation, and chronic indwelling ureteral stents. Once the diagnosis was established, both patients were managed with endovascular covered stent placement. The patients' conditions stabilized, hematuria ceased, and both were discharged from the hospital without additional transfusion or surgical treatment.


CONCLUSIONS
Endovascular therapy with covered stents is a safe, effective, and readily available method for the treatment of ureteral-iliac artery fistulae.
Madoff
David C
DC
Department of Diagnostic Radiology, St. Luke's Episcopal Hospital, 6720 Bertner Avenue MC 2-270, Houston, Texas 77030, USA. dmadoff@di.mdacc.tmc.edu
Toombs
Barry D
BD
Skolkin
Mark D
MD
Bodurka
Diane C
DC
Modesitt
Susan C
SC
Wood
Christopher G
CG
Hicks
Marshall E
ME
D000368:Aged; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008875:Middle Aged; D015607:Stents; D014515:Ureteral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D016157:Vascular Fistula / Q000601:surgery*