Intraoperative transvascular balloon catheter management for arterioureteral fistula

An arterioureteral fistula is a rare but intriguing anomaly. Fewer than two dozen cases have been recorded, and all have relayed the extreme diagnostic and therapeutic challenges that this entity presents to the clinician. Factors contributing to the development of such a fistula include prolonged ureteral catheterization, prior pelvic vascular or urologic surgery, cancer or radiation. These patients are severely debilitated, and repair has a mortality rate in excess of 15%. Experience with such a patient is reported, as well as use of a minimally invasive approach to repair the abnormality. By using transvascular balloon occlusion of the involved iliac vessel and extra-anatomic vascular reconstruction, the significant morbidity and mortality associated with this disorder were avoided. Suspicion of an arterioureteral fistula should be increased in those at risk and treatment can be effected with this minimally invasive method.