title: Endovascular Repair of an Iliac Ureteroarterial Fistula with Late Stent Thrombosis and Migration into the Bladder.
abstract: BACKGROUND
  Ureteroarterial fistulas are rare. We describe a case of ureteral-arterial fistulas (UAF) repaired with an endovascular stent graft and examine late complications associated with the procedure.
  
  
  METHODS
  A 37-year-old woman with a history of complicated locally invasive cervical cancer treated with chemoradiation presented initially with right leg rest pain and chronic intermittent gross hematuria. She was found to have an ureteroarterial fistula and underwent successful endovascular exclusion with a covered stent with resolution of her symptoms. She returned 1 year later with stent-graft thrombosis manifesting as lower extremity rest pain, requiring a femoral-femoral bypass. She then returned 6 months later with imaging evidence of extravascular migration of the stent graft into the bladder. Because of a poor prognosis of recurrent gynecologic cancer, extraction was not attempted, and she underwent complete urinary diversion.
  
  
  CONCLUSIONS
  UAFs are a rare occurrence but may be treated successfully with endovascular stent grafting. Despite technical success, late complications such as stent thrombosis may occur even with anticoagulation. Extravascular stent migration may occur in the presence of a chronically dilated ureter.
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: liangnl@upmc.edu.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Liang
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Efthymios D
authors.initials: ED
authors.lastname: Avgerinos
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hager
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Singh
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014547:Urinary Diversion; D014548:Urinary Fistula / Q000000981:diagnostic imaging / Q000628:therapy*; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000628:therapy*