Vol. 25 No. 3 (2021)
CASE REPORTS

Clinical case of successful endovascular correction of an arterio-ureteral fistula

PDF (Русский)
  • M.A. Chernyavsky,
  • M.S. Mosoyan,
  • A.G. Vanyurkin,
  • N.V. Susanin,
  • A.N. Kazantsev
M.A. Chernyavsky
Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, Saint Petersburg
Bio
M.S. Mosoyan
Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, Saint Petersburg
A.G. Vanyurkin
Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, Saint Petersburg
N.V. Susanin
Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, Saint Petersburg
A.N. Kazantsev
Almazov National Medical Research Centre, Ministry of Health of the Russian Federation, Saint Petersburg; Alexandrovskaya Hospital, Saint Petersburg
DOI: https://doi.org/10.21688/1681-3472-2021-3-100-105

Published 2021-09-28

Keywords

  • arterio-ureteral fistula,
  • evisceration of organs,
  • massive haematuria,
  • stent graft,
  • ureteral stent

How to Cite

Chernyavsky, M., Mosoyan, M., Vanyurkin, A., Susanin, N., & Kazantsev, A. (2021). Clinical case of successful endovascular correction of an arterio-ureteral fistula. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 25(3), 100–105. https://doi.org/10.21688/1681-3472-2021-3-100-105

Copyright (c) 2021 Chernyavsky M.A., Mosoyan M.S., Vanyurkin A.G., Susanin N.V., Kazantsev A.N.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Arterio-ureteral fistulas are a pathological condition characterised by the appearance of a defect between the blood vessels and adjacent distal segments of the ureter. Arterio-ureteral fistulas are relatively rare and potentially life-threatening, since they are associated with a high risk of developing haemorrhagic shock against the background of recurrent massive haematuria.
This study describes the successful endovascular treatment of arterio-ureteral fistulas in a 51-year-old female patient. Evisceration of the pelvic organs was performed, followed by uretero-cutaneostomy and colostomy. Ureteral stents were installed to improve the outflow of urine and prevent ureteral stenosis. After stent removal, episodes of recurrent profuse bleeding from uretero-cutaneostomy occurred. On admission, multi-spiral computed tomography with angiography of the iliac arteries was performed. Extravasation of the contrast agent was not detected; however, external compression of the left common iliac artery by the left ureter was identified. After further examination, a balloon-expandable stent-graft was implanted into the left common iliac artery. The postoperative period thereafter was uneventful.
This clinical case demonstrates the highly efficient endovascular treatment of the presented pathology and exemplifies the need for an integrated and multidisciplinary approach in the diagnosis and treatment of arterio-ureteral fistulas. Minimally invasive techniques can reduce surgical trauma and quickly isolate pathological blood discharge from the artery into the ureter. The advantages and disadvantages of endovascular technologies in the treatment of the presented pathology are also discussed.

Received 16 February 2021. Revised 11 March 2021. Accepted 12 March 2021.

Funding: The study did not have sponsorship.

Conflict of interest: The authors declare no conflicts of interests.

Contribution of the authors
Drafting the article: A.G. Vanyurkin, A.N. Kazantsev
Critical revision of the article: M.A. Chernyavsky, N.V. Susanin, M.S. Mosoyan
Surgical treatment: M.A. Chernyavsky, A.G. Vanyurkin, N.V. Susanin
Final approval of the version to be published: M.A. Chernyavsky, M.S. Mosoyan, A.G. Vanyurkin, N.V. Susanin, A.N. Kazantsev

PDF (Русский)

References

  1. Yoshioka N., Takagi K., Morita Y., Kawase M., Morishima I. Endovascular treatment of arterio-ureteral fistula with new-generation balloon-expandable stent graft using a 7-French system. SAGE Open Med Case Rep. 2020;8:2050313X20959219. PMID: 33062280; PMCID: PMC7534066. https://doi.org/10.1177/2050313X20959219
  2. Kaneko T., Sakamoto A., Yamada Y., Yamamoto M., Kondo H., Nakagawa T. Uretero-arterial fistula treated with endovascular stent graft following multiple interventions. IJU Case Rep. 2020;3(6):275-277. PMID: 33163924; PMCID: PMC7609180. https://doi.org/10.1002/iju5.12216
  3. Malgor R.D., Oderich G.S., Andrews J.C., McKusick M., Kalra M., Misra S., Gloviczki P., Bower T.C. Evolution from open surgical to endovascular treatment of ureteral-iliac artery fistula. J Vasc Surg. 2012;55(4):1072-1080. PMID: 22326578; PMCID: PMC4476467. https://doi.org/10.1016/j.jvs.2011.11.043
  4. Guntau M., Hegele A., Rheinheimer S., Hofmann R., Mahnken A.H. Balloon-expandable stent graft for treating uretero-iliac artery fistula. Cardiovasc Intervent Radiol. 2017;40(6):831-835. PMID: 28150018. https://doi.org/10.1007/s00270-017-1586-4
  5. Horie K., Fujiwara T., Satoyoshi K., Munehisa M., Inoue N. Endovascular treatment of ureteroarterial fistula using a covered stent, evaluated by intravascular ultrasound: a case report. CVIR Endovasc. 2019;2(1):16. PMID: 32026230; PMCID: PMC6966421. https://doi.org/10.1186/s42155-019-0060-6
  6. Gallo F., Gastaldi E., Spirito G., Barile A., Kosir C., Giberti C. A case of iliac-artery-ureteral fistula managed with a combined endoscopic approach. Nat Clin Pract Urol. 2008;5(4):225-228. PMID: 18334976. https://doi.org/10.1038/ncpuro1059
  7. Kuramoto T., Muraoka S., Nishikawa T., Matsumoto Y., Uokawa K. A Case of ureteroarterial fistula successfully treated with endovascular stent graft. Hinyokika Kiyo. 2019;65(7):299-303. PMID: 31501396. https://doi.org/10.14989/ActaUrolJap_65_7_299
  8. Araki T., Nagata M., Araki T., Takihana Y., Takeda M. Endovascular treatment of ureteroarterial fistulas with stent-grafts. Radiat Med. 2008;26(6):372-375. PMID: 18677613. https://doi.org/10.1007/s11604-008-0235-x
  9. Krenzien J., Wagner R. Iliac artery-ureteral fistula and its treatment. Zentralbl Chir. 2003;128(9):768-773. PMID: 14533048. https://doi.org/10.1055/s-2003-42757
  10. Mahlknecht A., Bizzotto L., Gamper C., Wieser A. A rare complication of ureteral stenting: Case report of a uretero-arterial fistula and revision of the literature. Arch Ital Urol Androl. 2018;90(3):215-217. PMID: 30362691. https://doi.org/10.4081/aiua.2018.3.215
  11. Madonia M., Russo G.I., Trignano E., Paliogiannis P., Cimino S., Corbu C., Morgia G. A case of gross haematuria due to an ureteric-iliac artery fistula. Ann Ital Chir. 2013;84(ePub):S2239253X13021750. PMID: 24395028.