Abstract
Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up. Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery. Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.
Highlights
First described by Moschcowitz in 1908, arterio-ureteral fistula (AUF) is a rare vascular condition referring to the anomalous formation of a connection between an iliac artery and the ureter 1
Aim of this study is to present our experience with open and endovascular techniques for this type of pathology, especially with respect to mid-term durability
All patients had a previous history of laparotomy, with six of them having a medical history of malignancy
Summary
First described by Moschcowitz in 1908, arterio-ureteral fistula (AUF) is a rare vascular condition referring to the anomalous formation of a connection between an iliac artery and the ureter 1. Arterio-ureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter It is often associated with pelvic malignancy, abdominal surgery and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. Recurrent hematuria and stentgraft infection were observed during follow-up in three patients following endovascular repair, all of them treated through open surgery with no further complications. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding
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