Endovascular treatment of a ureteroiliac fistula associated with ureteral double J-stenting and an aortic-bifemoral stent graft for an inflammatory abdominal aortic aneurysm.
We report an unusual case of a ureteroiliac fistula due to prolonged ureteral stenting for hydronephrosis combined with an aortic-bifemoral stent graft in an inflammatory abdominal aortic aneurysm (AAA), treated with an endovascular stent graft. In a 77-year-old man ureteral J-stents were placed for bilateral hydronephrosis due to retroperitoneal fibrosis caused by an inflammatory AAA. The aneurysm was treated with an endovascular aortic-bifemoral stent graft. Three months later, the patient suffered from severe hypovolemic shock. Emergency angiography showed a fistula between the right ureter and the right common iliac artery just distal to the right leg of the stent graft. The ureteroiliac fistula was treated with a wall graft (10F). The patient recovered well and remained asymptomatic. Ureteroiliac fistula remains a rare complication of ureteral stenting. Several risk factors have been described before. This case emphazes the increased risk of an arterial-ureteral fistula due to an indwelling ureteral stent and an inflammatory AAA, especially in combination with an additional stent graft for this inflammatory AAA.
Meester
Daan J
DJ
Department of Vascular Surgery, St. Lucas Hospital, Ghent, Belgium.
van Muiswinkel
Krijn W
KW
Ameye
Filip
F
Fransen
Hendrik
H
Stockx
Luc
L
Merckx
Luc
L
Nevelsteen
Andre
A
D000368:Aged; D017130:Angioplasty; D001011:Aorta / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008297:Male; D011859:Radiography; D015607:Stents / Q000009:adverse effects*; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014546:Urinary Catheterization / Q000009:adverse effects*; D014548:Urinary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*