Embolization with Tornado coils to control bleeding from an arterioureteral fistula.
Arterioureteral fistulae are rare, but potentially life-threatening causes of bleeding. We present a case of an 82 year-old woman with refractory, transfusion-dependent bleeding from an arterial fistula to her right ureteral stump, following right radical nephrectomy for advanced renal cell carcinoma. Cystoscopy with retrograde ureteral stump embolization using Tornado (Cook Medical, Bloomington, Indiana, USA) coils plus a slurry of thrombin-soaked Gelfoam (Pfizer Inc., New York, New York, USA) was performed, which led to prompt resolution of the patient's hematuria requiring no further hospitalizations or transfusions. Retrograde insertion of coils and injection of thrombin-soaked Gelfoam can be a minimally invasive, safe, and durable alternative for controlling hemorrhage from an arterioureteral fistula to a ureteral stump.
Jacobs
Bruce L
BL
Department of Urology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15213, USA.
Maranchie
Jodi K
JK
D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D009392:Nephrectomy / Q000009:adverse effects; D014515:Ureteral Diseases / Q000150:complications*; D014548:Urinary Fistula / Q000150:complications*; D016157:Vascular Fistula / Q000150:complications*