Treatment of ureteroarterial fistulae with covered vascular endoprostheses and ureteral occlusion.
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.


CONCLUSIONS
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.
Bilbao
Jose' I
JI
Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII 36, 31008 Pamplona, Spain. jibilbao@unav.es
Cosín
Octavio
O
Bastarrika
Gorka
G
Rosell
David
D
Zudaire
Javier
J
Martínez-Cuesta
Antonio
A
D000368:Aged; D017541:Aneurysm, False / Q000628:therapy; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D004621:Embolization, Therapeutic / Q000295:instrumentation; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007511:Ischemia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011138:Polytetrafluoroethylene; D015607:Stents; D014513:Ureter / Q000098:blood supply / Q000601:surgery*; D014515:Ureteral Diseases / Q000601:surgery*; D014548:Urinary Fistula / Q000601:surgery*; D016157:Vascular Fistula / Q000601:surgery*
D011138:Polytetrafluoroethylene