Management Strategy for Ureteral–Iliac Artery Fistula

Abstract

Ureteral-iliac artery fistula (UIAF) is a rare but a potentially life-threatening condition. In this study, we reported our results of UIAF treated by open surgical and endovascular treatment. In this single-center, retrospective observational cohort study, we reviewed 6 consecutive patients who were diagnosed with a UIAF and received either open surgical or endovascular treatment based on the specific risk profile of each patient. All patients had an indwelling ureteral stent for a ureteral stricture, with an average ureteral stenting duration of 22months (range, 1-74months), and 2 patients had a history of endovascular treatment with stent grafts for UIAF. Contrast-enhanced computed tomographic angiography was positive in 4 patients. Blood and urine cultures were positive in 2 and 4 patients, respectively. Four patients, including 2 with previously failed endovascular treatment, received open surgical repair. The remaining 2 patients received either endovascular treatment with stent grafts or a hybrid procedure. During the mean follow-up period of 20.3months (range, 6-29months), there was no symptomatic recurrence of the UIAF. A multidisciplinary approach is highly preferable for treating potentially life-threatening UIAF. Endovascular treatment with stent grafts is currently recommended in selected patients whenever possible, but open surgical treatment is required in certain patients with enteric contamination, abscess, local sepsis, or previously failed endovascular treatment.