title: Long-term results of endovascular stent graft placement of ureteroarterial fistula.
abstract: OBJECTIVE
  To evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF).
  
  
  METHODS
  We retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated.
  
  
  RESULTS
  Stent graft placement for 11 UAFs was performed (4 men, mean age 72.8 ± 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91%), pelvic surgery in 8 (73%), and pelvic radiation in 5 (45%). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55%). In the remaining 5 (45%), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36%) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6%, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9%, respectively.
  
  
  CONCLUSIONS
  Endovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary.
authors.affiliation: Department of Radiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. okabone@gmail.com
authors.forename: Takuya
authors.initials: T
authors.lastname: Okada
authors.forename: Masato
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Akhmadu
authors.initials: A
authors.lastname: Muradi
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Nomura
authors.forename: Kensuke
authors.initials: K
authors.lastname: Uotani
authors.forename: Koji
authors.initials: K
authors.lastname: Idoguchi
authors.forename: Naokazu
authors.initials: N
authors.lastname: Miyamoto
authors.forename: Ryota
authors.initials: R
authors.lastname: Kawasaki
authors.forename: Takanori
authors.initials: T
authors.lastname: Taniguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D015331:Cohort Studies; D003287:Contrast Media; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D014548:Urinary Fistula / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*
chemical_list: D003287:Contrast Media