title: [Endoscopic treatment with Wallgraft stenting of complete iatrogenic iliac ureteral injury in a high-risk surgical patient].
abstract: BACKGROUND
  Injury of the ureter is a potential complication of any difficult abdominopelvic surgical procedure, with an incidence ranging between 0.5% and 10% in most series. The treatment depends on the severity and the place of the lesion. The severe mid and upper ureteral injuries usually require complex treatment procedures, which can be contraindicated in case of severe comorbidities with high anesthesiologic risk. We report our experience in the endoscopic treatment with Wallgraft stenting of complete iatrogenic iliac ureteral injury in a high-risk surgical patient.
  
  
  METHODS
  A 74-year-old female patient was admitted at our department due to a complete lesion of the right iliac ureter following right iliac artery aneurysm repair with iatrogenic ileal injury. The patient was in coma, affected by severe respiratory insufficiency, sepsis and uroperitoneum. These conditions contraindicated a general anesthesia encumbering the positioning of a nephrostomy, and influenced our indication of Wallgraft stent placement. The Wallgraft endoprosthesis (10 x 50 mm) is a self-expanding super-alloy metallic high flexible stent covered by PET, which can be placed at the level of the lesion using fluoroscopy after introducing an angiographic catheter and guidewire. This procedure is usually indicated in the treatment of vascular lesions.
  
  
  RESULTS
  After positioning the Wallgraft stent, pyelography showed a complete closure of the lesion. The patient's clinical condition improved quickly and remained stable at a follow-up of 45 months.
  
  
  CONCLUSIONS
  Although the Wallgraft stent positioning cannot be considered as a standard treatment for all the complete ureteral lesions, it can be proposed in the management of some patients with severe comorbidities, which do not allow any other approach.
authors.affiliation: Dipartimento di Chirurgia, Struttura Complessa, Ospedale San Paolo, Via Genova 38, Savona, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bonamini
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ninotta
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gallo
authors.forename: Emilio
authors.initials: E
authors.lastname: Gastaldi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Schenone
authors.forename: Claudio
authors.initials: C
authors.lastname: Giberti
authors.forename: Antonio
authors.initials: A
authors.lastname: Barile
mesh_terms: D000368:Aged; D017546:Angioscopy; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D017543:Iliac Aneurysm / Q000601:surgery*; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries*