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- W2804686135 abstract "Ureteral-arterial fistulas are a rare and life-threatening source of hematuria. They are caused by inflammatory and fibrocystic changes that become erosive defects between the ureter and adjacent iliac arteries. They occur more frequently in women and are associated with pelvic irradiation, ureteral and arterial manipulation, malignant disease, and pelvic or abdominal surgery. Here we describe one case and review five cases of endovascular repair. We reviewed five cases of ureteral-arterial fistulas treated during the last 7 years at a single institution (Table). A 70-year-old woman with a history of cervical cancer status post total abdominal hysterectomy and external beam radiotherapy developed bilateral ureteral strictures requiring chronic bilateral ureteral stenting. She had a history of a right ureteral-arterial fistula 7 years ago that was treated with coil embolization of the right internal iliac artery and a covered stent from the common iliac to the external iliac. She was transferred from an outside hospital after gross hematuria was noted during the removal of the left ureteral stent, raising suspicion for a ureteral-iliac fistula. Ureteroscopy showed pulsatile bleeding below the pelvic brim, and a balloon was inflated in the ureter to tamponade the bleed. Selective arteriography of the left external iliac artery with the balloon temporarily deflated showed dye extravasation into the ureter. An 8-mm by 5-cm covered Viabahn stent (W. L. Gore & Associates, Flagstaff, Ariz) was deployed across the defect, and follow-up arteriography showed no bleeding into the ureter. The patient's hematuria resolved. The endovascular approach to repair of ureteral-arterial fistulas can reliably produce good outcomes. However, infection remains a major pitfall to endovascular repair. In the setting of infections with previous endovascular repair, it is advisable to remove all prosthetics, to ligate the ipsilateral iliac artery, and to perform a femoral-femoral bypass.TableFive cases of ureteral-arterial fistulasPatientIndicationSiteProcedureOutcome170-year-old woman with history of bilateral ureteral strictures and previous repair of right ureteral-arterial fistulaLeft external iliacCoil-embolized right internal iliac8-mm × 5-cm Viabahn stent across defectSuccessful repair277-year-old woman with history of pelvic irradiation and bilateral pelvic irradiationRight internal iliacCoil embolized16-mm × 12-mm × 7-cm endograftSuccessful repair358-year-old woman with history of pelvic irradiationRight internal iliac5 × 22-mm iCastSuccessful repair457-year-old woman with history of pelvic irradiationRight common iliac9-mm × 10-cm Viabahn stent graft in right common and external iliacSuccessful repair557-year-old man with history of colon cancer with hematuria through nephrostomy/urostomy through ileal conduitLeft common iliac arteryMultiple coil embolizations and stent graftsAmplatz plug placed at origin of left common iliac arteryFemoral-femoral bypass with autologous great saphenous veinTolerated initial procedure wellLater arteriography showed bleed from left iliac artery stumpDeath Open table in a new tab" @default.
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- W2804686135 date "2018-06-01" @default.
- W2804686135 modified "2023-09-30" @default.
- W2804686135 title "IP239. A Fatal Cause of Hematuria" @default.
- W2804686135 doi "https://doi.org/10.1016/j.jvs.2018.03.204" @default.
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