A primary arterial-ureteral fistula after an aortic-bifemoral bypass

Primary arterial-ureteral fistula is a rare and diagnostically challenging condition which may present with massive hematuria.

A case of primary arterial-ureteral fistula (AUF) is presented in a patient with a previous prosthetic aortic-bifemoral bypass. The AUF treated with arterial and ureteral resection, arterial ligation and ureteral reconstruction.

Primary AUF are more frequently associated with aneurysmal degeneration of the arterial wall. The development of a primary fistula due to an iliac artery aneurysm many years after an aortic-bifemoral bypass performed due to atherosclerotic obstructive disease is a very unusual presentation of this entity. Multiple surgical strategies can be employed in achieving hemorrhage and infection control, urinary tract continuity, and vascular reconstruction.

A multidisciplinary approach and the achievement of a pre-operative diagnosis are essential for an effective management of this condition with prognostic implications.