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- W2982157675 abstract "Ureteral-arterial fistula is a rare and complex entity that poses a challenge for the vascular surgeon. It has been described in the literature more than 150 times dating back to the first reported case in 1908. An endovascular approach to repair has recently been popularized because of its minimally invasive nature. In this manuscript, we present a case report, review the literature, and propose that an open approach may provide a superior repair in the correct clinical scenario. Our patient is a 78-year-old man who originally presented with septic shock secondary to a urinary tract infection. The patient had a previous radical cystoprostatectomy with ileal conduit creation for recurrent bladder cancer. He requires long-term indwelling ureteral stents for recurrent strictures at the ureteroneocystostomy. On a recent stent exchange, pulsatile bleeding was noted from the ileal conduit ostomy. Proximity of the left ureteral stent to the iliac artery was evident on computed tomography angiography. Given the recurrent infections of his indwelling ureteral stents, stent graft repair had a high likelihood of infection; it was determined that a definitive repair with excision of the fistula would be the most appropriate. He ultimately required excision and ligation of the ureter and fistulous track, with primary repair of the left common iliac artery. Contemporary literature reviews have been performed of ureteral-arterial fistulas. Since 1997, the prevailing method of repair has been through an endovascular approach. However, the endovascular approach with stent graft placement is not without risk, including stent graft infections. Open repair provides a definitive solution to a difficult problem. Ureteral-arterial fistula presents a unique and challenging problem. Currently, the literature favors an endovascular approach to repair of ureteral-arterial fistulas. However, a case-by-case approach should be undertaken to identify the most appropriate repair for each patient. It is our position that when concern for contamination exists and the patient is an acceptable preoperative risk, an open approach with a primary or autogenous repair is the most appropriate." @default.
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- W2982157675 date "2019-11-01" @default.
- W2982157675 modified "2023-10-18" @default.
- W2982157675 title "FJVIS 2. Ureteral-Arterial Fistula—A Role for Open Operation in the 21st Century" @default.
- W2982157675 doi "https://doi.org/10.1016/j.jvs.2019.08.186" @default.
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