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Published on: December 20, 2014
A case of iliac-artery-ureteral fistula managed with a combined endoscopic approach
Fabrizio Gallo1, Emilio Gastaldi, Gianpiero Spirito
1Division of Urology, San Paolo Hospital, Savona, Italy. gallo.fabrizio@fastwebnet.it
Insights
A patient with gross hematuria due to an iliac artery pseudoaneurysm and ureteral fistula was successfully treated with a covered vascular stent. This endovascular repair resolved the fistula and hematuria, improving patient outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Urology
Background:
- A 66-year-old male presented with gross hematuria and clots.
- History of right iliac artery aneurysm repair with a vascular prosthesis.
- Complicated by iliac urethral stricture requiring a right ureteral stent, with recurrent stent replacements.
Observation:
- The patient presented with significant hematuria and a history of complex vascular and ureteral issues.
- Diagnostic imaging included ultrasonography, cystography, retrograde pyelography, and provocative arteriography.
- Diagnosis revealed an iliac artery-ureteral fistula between the right ureter and a right common iliac artery pseudoaneurysm.
Findings:
- Endovascular repair using a covered, self-expandable vascular stent with angioplasty.
- Successful exclusion of the pseudoaneurysm and fistula.
- Resolution of gross hematuria and restoration of right iliac artery patency confirmed by Color-Doppler ultrasonography.
Implications:
- Covered stent placement is an effective treatment for complex iliac artery pseudoaneurysms with associated fistulas.
- Minimally invasive endovascular techniques can successfully manage iatrogenic arterioureteral fistulas.
- This approach offers a viable alternative to open surgical repair for such challenging cases.
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.
Investigations:
Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach.
Diagnosis:
An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery.
Management:
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.
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