A case of iliac-artery-ureteral fistula managed with a combined endoscopic approach.
BACKGROUND
A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac urethral stricture that required the placement of a right ureteral stent. He had attended repeatedly for recurrent ureteral stent replacement, with the most recent replacement having occurred 1 month before the current presentation.


METHODS
Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach.


METHODS
An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery.


RESULTS
The patient underwent placement of a covered, self-expandable vascular stent with angioplasty balloon, which resulted in complete exclusion of the pseudoaneurysm and fistula and resolution of the patient's hematuria. A pigtail catheter was placed in the right ureter for 5 days and replaced with a double-J ureteral stent on day 6 after exclusion of the pseudoaneurysm; the patient was discharged from hospital on the same day. Color-Doppler ultrasonography of the right iliac vessels performed 2 months later showed patency of the right iliac artery. The patient's ureteral stent has been replaced every 2 months since his discharge without recurrence of hematuria.
Gallo
Fabrizio
F
Division of Urology, San Paolo Hospital, Savona, Italy. gallo.fabrizio@fastwebnet.it
Gastaldi
Emilio
E
Spirito
Gianpiero
G
Barile
Antonio
A
Kosir
Corrado
C
Giberti
Claudio
C
D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000628:therapy; D000800:Angioplasty, Balloon; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D008297:Male; D015607:Stents; D014513:Ureter / Q000601:surgery*; D014548:Urinary Fistula / Q000175:diagnosis / Q000628:therapy*; D016157:Vascular Fistula / Q000175:diagnosis / Q000628:therapy*