Treatment of ureteroarterial fistulae with covered vascular endoprostheses and ureteral occlusion
Bilbao JI, Cosín O, Bastarrika G [SP], Rosell D [SP], Martínez-Cuesta A.
Department of Radiology, Clínica Universitaria de Navarra, Universidad de Navarra, Avenida de Pio XII 36, 31008 Pamplona, Spain.
Magazine: Cardiovascular and Interventional Radiology
Date: Mar 1, 2005Urology [SP] Radiology [SP]
Ureteroarterial fistulae (UAFs) are a rare entity, often difficult to identify, and associated with a high mortality rate. This fact has been attributed to a delay in diagnosis and treatment. Five conditions that can predispose to the development of this uncommon entity have been described: prior pelvic surgery, prolonged ureteral stenting, radiation therapy, previous vascular surgery and vascular pathology.
We present 4 patients with UAFs and at least three of the above-mentioned conditions. Ureteral ischemia and subsequent necrosis promote the formation of these fistulae. The constant pulsation of the iliac artery is transmitted to an already compromised ureter containing a stiff intraluminal foreign body, resulting in pressure necrosis, most likely where the ureter crosses the iliac artery.
RESULTS AND CONCLUSION
Cases were managed percutaneously with a combination of the deployment of a covered prosthesis and, when needed, with mechanical occlusion of the ureter. Hematuria stopped in all the patients with no evidence of immediate rebleeding. One patient presented a new episode of vaginal bleeding 13 months after endograft placement and ureteral embolization.
Arteriography showed the presence of a hypogastric artery pseudoaneurysm that was occluded using coils. No new bleeding has occurred in this patient 12 months after the second embolization. At present all 4 patients are alive with follow-up periods of 5, 9, 11 and 25 months since the first procedure.
CITATION Cardiovasc Intervent Radiol. 2005 Mar-Apr;28(2):159-63
you maybe interested
The Clínica is the greater private hospital with technological equipment of Spain, all in a single center.
The professionals of the Clínica perform continuous research and training, always to the benefit of the patient.
Learn why we are different from other healthcare centers. Quality, speed, comfort and results.