Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors’ hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review.
Methods:
Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: “uretero arterial fistula” and “uretero iliac fistula.” It includes only articles reporting the endovascular management.
Results:
Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1).
Conclusion:
Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.
MoschcowitzA. Simultaneous ligation of both external iliac arteries for secondary hemorrhage following bilateral ureterolithotomy. Ann Surg. 1908;48(6):872–875.
2.
van den BerghRCMollFLde VriesJPLockTM. Arterioureteral fistulas: unusual suspects systematic review of 139 cases. Urology. 2009;74(2):251–255.
3.
DasALewandoskiPLaganoskyDWaltonJShenotP. Ureteroarterial fistula: a review of the literature. Vascular. 2016;24(2):203–207.
4.
StroupDFBerlinJAMortonSC. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012.
5.
QuillinSPDarcyMDPicusD. Angiographic evaluation and therapy of ureteroarterial fistulas. AJR Am J Roentgenol. 1994;162(4):873–878.
6.
KernsDBDarcyMDBaumannDSAllenBT. Autologous vein-covered stent for the endovascular management of an iliac artery-ureteralfistula: case report and review of the literature. J Vasc Surg. 1996;24(4):680–686.
7.
FeuerDSCioccaRGNackmanGBSiegelRLGrahamAM. Endovascular management of ureteroarterial fistula. J Vasc Surg. 1999;30(6):1146–1149.
8.
MatsuiYFujikawaKOkaHFukuzawaSTakeuchiH. Ureteroarterial fistula in a patient with a single functioning kidney. Int J Urol. 2001;8(3):128–129.
BilbaoJICosínOBastarrikaGRosellDZudaireJMartínez-CuestaA. Treatment of ureteroarterial fistulae with covered vascular endoprostheses and ureteral occlusion. Cardiovasc Intervent Radiol. 2005;28(2):159–163.
13.
OtaTTsujiYKawasakiRTaniguchiTMorimotoYOkitaY. Endovascular treatment of aortoureteric fistula. J Endovasc Ther. 2005;12(3):411–413.
14.
MeesterDJvan MuiswinkelKWAmeyeF. Endovascular treatment of a ureteroiliac fistula associated with ureteral double J-stenting and an aortic-bifemoral stent graft for an inflammatory abdominal aortic aneurysm. Ann Vasc Surg. 2006;20(3):408–410.
15.
FuJHLiangHLYuCCPanHBYangCF. Percutaneous endovascular repair of a ureteroarterial fistula with a stent graft. J Chin Med Assoc. 2006;69(8):387–190.
16.
MuraokaNSakaiTKimuraH. Endovascular treatment for an iliac artery-ureteral fistula with a covered stent. J Vasc Interv Radiol. 2006;17(10):1681–1685.
17.
GalloFGastaldiESpiritoGBarileAKosirCGibertiC. A case of iliac-artery-ureteral fistula managed with a combined endoscopic approach. Nat Clin Pract Urol. 2008;5(4):225–228. doi: 10.1038/ncpuro1059.
18.
PappyRAbu-FadelMHennebryT. Ureteroarterial fistula: a rare cause of hematuria managed in the cardiac cath lab. J Invasive Cardiol. 2008;20(5): E158–E160.
19.
ArakiTNagataMArakiTTakihanaYTakedaM. Endovascular treatment of ureteroarterial fistulas with stent-grafts. Radiat Med. 2008;26(6):372–375. doi: 10.1007/s11604-008-0235-x.
20.
MitterbergerMFrauscherFSteppanIPeschelRPinggeraGM. Ureteroiliac fistula: a case report review of the literature. Cases J. 2009;2:6266. doi: 10.4076/1757-1626-2-6266.
21.
KimDHMahdyAMundraVBermanMGhoniemGM. Ureteroarterial fistula. Case Rep Med. 2009;2009:326969. doi: 10.1155/2009/326969.
22.
YamasakiKOmoriKTakaokaE. Successful management by provocative angiography and endovascular stent of ureteroarterial fistula in a patient with a long-term indwelling ureteral stent. Jpn J Clin Oncol. 2010;40(3):267–270. doi: 10.1093/jjco/hyp154.
23.
SantarpiaLCretaMBracaleUM. Ureteroiliac artery fistula in a young woman with short bowel syndrome for radiation enteritis. Case Rep Med. 2010;2010:287034. doi:10.1155/2010/287034.
24.
AslamMZKheradmundFPatelNCranstonD. Uretero-iliac artery fistula: a diagnostic and therapeutic challenge. Adv Urol. 2010:276497. doi: 10.1155/2010/276497.
25.
VeenstraGMFossionLMDebonnaireGde LaetK. Endovascular treatment of a right-sided ureteroiliac fistula in a patient with a simultaneous left-sided ureteroileal fistula. Case Rep Urol. 2011;2011:284505. doi: 10.1155/2011/284505.
26.
MalgorRDOderichGSAndrewsJC. Evolution from open surgical to endovascular treatment of ureteral-iliac artery fistula. J Vasc Surg. 2012;55(4):1072–1080. doi: 10.1016/j.jvs.2011.11.043.
DormeusSHernándezEANicolazziM. Ureteroiliac fistula secondary to radiotherapy in a patient with a single renal metastasis of colon adenocarcinoma. Can Urol Assoc J. 2013;7(1-2):E146–E149. doi: 10.5489/cuaj.259.
29.
TselikasLPellerinODi PrimioM. Ureteroiliac fistula: modern treatment via the endovascular route. Diagn Interv Imaging. 2013;94(3):311–318. doi: 10.1016/j.diii.2012.10.005.
30.
OkadaTYamaguchiMMuradiA. Long-term results of endovascular stent graft placement of ureteroarterial fistula. Cardiovasc Intervent Radiol. 2013;36(4):950–956. doi: 10.1007/s00270-012-0534-6.
31.
AtmacaAFCandaAEGumusMAsilEBalbayMD. Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: endovascular management of an unusual complication. Can Urol Assoc J. 2013;7(9-10):E605–E608. doi: 10.5489/cuaj.170.
32.
MadoniaMRussoGITrignanoE. A case of gross haematuria due to an ureteric-iliac artery fistula. Ann Ital Chir. 2013;84(ePub). pii: S2239253X13021750.
33.
PozzilliPLentiMMoscaSNunziEMeariniL. Ureteroarterial fistula from ureteral stump: a challenging case. Case Rep Urol. 2014;2014:514625. doi: 10.1155/2014/514625.
34.
MuradiAYamaguchiMIdoguchiK. Lessons learned from endovascular management of ureteroarterial fistula. Vasc Endovascular Surg. 2014;48(2):159–161. doi: 10.1177/1538574413510620.
35.
BietzGHouseAEricksonDEndeanED. Diagnosis and treatment of arterial-ureteric fistula. J Vasc Surg. 2014;59(6):1701–1704. doi: 10.1016/j.jvs.2013.06.015.
36.
CopelanAChehabMCashCKormanHDixitP. Endovascular management of ureteroarterial fistula: a rare potentially life threatening cause of hematuria. J Radiol Case Rep. 2014;8(7):37–45. doi: 10.3941/jrcr.v8i7.1879.
37.
PatelDKumarARanganathPContractorS. Endovascular treatment of arterio-ureteral fistulae with covered stents: case series and review of the literature. SAGE Open Med Case Rep. 2014;2:2050313X14548094. doi: 10.1177/2050313X14548094.
38.
RafieiAWeberTAKongnyuyMOrdoricaR. Bilateral ureteral-iliac artery fistula in a patient with chronic indwelling ureteral stents: a case report and review. Case Rep Urol. 2015;2015:826760. doi: 10.1155/2015/826760.
39.
TakaseYKodamaKMotoiI. Successful endovascular treatment using a covered stent for artery-ureteral fistula after surgery for abdominal aortic aneurysm. Indian J Urol. 2015;31(3):256–258. doi: 10.4103/0970-1591.159668.
40.
PalmerolaRWestermanMEFakhouryMBoorjianSARichstoneL. Ureteroarterial fistulas after robotic and open radical cystectomy. J Endourol Case Rep. 2016;2(1):48–51. doi: 10.1089/cren.2015.0034.
41.
LiangNLAvgerinosEDHagerESSinghMJ. Endovascular repair of an iliac ureteroarterial fistula with late stent thrombosis and migration into the bladder. Ann Vasc Surg. 2016;35:204.e5–204.e7. doi: 10.1016/j.avsg.2016.01.026.
42.
MelegariSPaparellaSFolliniML. Bilateral ureteroarterial fistula: a case report and review of literature. Urologia. 2016;83(3):168–172. doi:10.5301/uro.5000164.
43.
HongSYNohMKoGY. Management strategy for ureteral-iliac artery fistula. Ann Vasc Surg. 2016;36:22–27. doi: 10.1016/j.avsg.2016.02.033.
44.
DasKOrdonesFWelikumburaSBrookNR. Ureteroiliac artery fistula caused by a metallic memokath ureteral stent in a radiation-induced ureteral stricture. J Endourol Case Rep. 2016;2(1):162–165.
45.
MujoTPriddyEHarrisJJPoulosESammanM. Unique presentation of hematuria in a patient with arterioureteral fistula. Case Rep Radiol. 2016;2016:8682040. doi: 10.1155/2016/8682040.
46.
JoglekarOVBhatiBBPatelDR. Ureter-iliac artery graft-cutaneous fistula: a rare presentation. Urol Ann. 2017;9(2):177–179. doi: 10.4103/UA.UA_111_16.
KibrikPEisenbergJBjurlinMAMarksNHingoraniAAscherE. Endoureteral coil embolization of an ureteral arterial fistula. Vascular. 2017;25(5):557–560. doi: 10.1177/1708538117704522.
49.
Lara-HernándezRRiera VázquezRBenabarre CastanyNSanchisPLozano VilardellP. Ureteroarterial fistulas: diagnosis, management, and clinical evolution. Ann Vasc Surg. 2017;44:459–465. doi: 10.1016/j.avsg.2017.05.001.
50.
MerzeauNRiquetHNicolacopoulosIAlameALarréS. Arterioureteral fistula: treatment of a hemorrhagic shock with massive hematuria by placing a balloon catheter. Case Rep Urol. 2017;2017:9453618. doi: 10.1155/2017/9453618.
51.
MadoffDCToombsBDSkolkinMD. Endovascular management of ureteral-iliac artery fistulae with Wallgraft endoprostheses. Gynecol Oncol. 2002;85(1):212–217.
52.
van den BerghRCMollFLde VriesJPYeungKKLockTM. Arterio-ureteral fistula: 11 new cases of a wolf in sheep’s clothing. J Urol. 2008;179(2):578–581.
53.
KrambeckAEDiMarcoDSGettmanMTSeguraJW. Ureteroiliac artery fistula: diagnosis and treatment algorithm. Urology. 2005;66(5):990–994.
54.
PillaiAKAndersonMEReddickMASutphinPDKalvaSP. Ureteroarterial fistula: diagnosis and management. AJR Am J Roentgenol. 2015;204(5):592–598.
55.
AndradaAOGarcíaILCanetFADAlcáñizJJFLavalleLLFRevillaFJB. An unusual cause of massive hematuria: arterio-ureteral fistula, and review of the literature. Int Arch Urol Complic. 2015;1:1–3.
56.
FoxJAKrambeckAMcPhailEFLightnerD. Ureteroarterial fistula treatment with open surgery versus endovascular management: long-term outcomes. J Urol. 2011;185(3):945–950. doi: 10.1016/j.juro.2010.10.062.
57.
KuntzNJInmanBA. Report of a rare fistula between a Studer neobladder and external iliac artery. Can Urol Assoc J. 2013;7(9-10):645–647.
