Ureteroarterial fistula: a case report.

Area of Science:

• Vascular surgery
• Urology
• Gynecologic oncology

Background:

• Pelvic exenteration is a radical surgical procedure for advanced pelvic malignancies.
• Iatrogenic arterioureteral fistulas are rare but serious complications, particularly after pelvic surgery and radiation therapy.
• Indwelling ureteral stents are often used to manage urinary obstruction but can be associated with complications.

Observation:

• A patient who underwent pelvic exenteration for cervical cancer developed a fistula between the right common iliac artery and the distal right ureter.
• The patient had received prior radiation therapy and had an indwelling ureteral stent at the time of fistula development.
• Diagnosis was confirmed via an occlusive ureterogram, visualizing the abnormal connection.

Findings:

• The arterioureteral fistula was successfully treated using embolization of the right common iliac artery.
• This endovascular technique effectively occluded the arterial supply to the fistula, resolving the complication.
• No immediate complications were reported following the embolization procedure.

Implications:

• This case highlights a rare but manageable complication following pelvic exenteration and radiation for cervical cancer.
• Embolization offers a minimally invasive and effective treatment option for arterioureteral fistulas.
• Understanding risk factors and prompt diagnosis are crucial for successful management of such vascular-ureteral injuries.