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Simon B, Neubauer J, Schoenthaler M, et al. Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature. CVIR Endovasc. 2021;4(1):36doi: 10.1186/s42155-021-00226-6.
Simon, B., Neubauer, J., Schoenthaler, M., Hein, S., Bamberg, F., & Maruschke, L. (2021). Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature. CVIR endovascular, 4(1), 36. https://doi.org/10.1186/s42155-021-00226-6
Simon, Bjoern, et al. "Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature." CVIR endovascular vol. 4,1 (2021): 36. doi: https://doi.org/10.1186/s42155-021-00226-6
Simon B, Neubauer J, Schoenthaler M, Hein S, Bamberg F, Maruschke L. Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature. CVIR Endovasc. 2021 Apr 17;4(1):36. doi: 10.1186/s42155-021-00226-6. PMID: 33864536; PMCID: PMC8053137.
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CVIR Endovasc. 2021 Apr 17;4(1):36. doi: 10.1186/s42155-021-00226-6.

Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature.

CVIR endovascular

Bjoern Simon, Jakob Neubauer, Martin Schoenthaler, Simon Hein, Fabian Bamberg, Lars Maruschke

Affiliations

  1. Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. [email protected].
  2. Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  3. Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  4. Diagnostic Radiology, Pediatric Radiology and Interventional Radiology, St.-Josefs-Krankenhaus, Freiburg, Germany.

PMID: 33864536 PMCID: PMC8053137 DOI: 10.1186/s42155-021-00226-6

Abstract

BACKGROUND: Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment.

METHODS: This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management.

RESULTS: We identified 17 UAF in 16 patients (12 male, 4 female, mean age 69.8 ± 11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1-3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases (82.4%). Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%).

CONCLUSION: Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary.

EVIDENCE-BASED MEDICINE: Level 4, case series.

Keywords: Arterioureteral fistula; Coil embolization; Endovascular therapy; Hematuria; Stent graft; Ureteral catheterization; Ureteroarterial fistula

References

  1. Ann Vasc Surg. 2016 Oct;36:22-27 - PubMed
  2. J Vasc Surg Cases Innov Tech. 2020 Apr 14;6(2):199-204 - PubMed
  3. Vascular. 2016 Apr;24(2):203-7 - PubMed
  4. J Endourol. 2018 Mar;32(3):245-251 - PubMed
  5. Aktuelle Urol. 2014 May;45(3):204-8 - PubMed
  6. J Urol. 2011 Mar;185(3):945-50 - PubMed
  7. Vasc Endovascular Surg. 2018 May;52(4):275-286 - PubMed
  8. Int Urol Nephrol. 2019 May;51(5):789-793 - PubMed
  9. Eur J Vasc Endovasc Surg. 2001 Sep;22(3):191-6 - PubMed
  10. Cardiovasc Intervent Radiol. 2017 Jun;40(6):831-835 - PubMed
  11. Vasa. 2021 Apr;50(3):193-201 - PubMed
  12. SAGE Open Med Case Rep. 2014 Aug 28;2:2050313X14548094 - PubMed
  13. Catheter Cardiovasc Interv. 2019 Jun 1;93(7):1374-1381 - PubMed
  14. Urology. 2009 Aug;74(2):251-5 - PubMed
  15. Radiol Case Rep. 2021 Feb 15;16(4):968-970 - PubMed
  16. Cardiovasc Intervent Radiol. 2005 Mar-Apr;28(2):159-63 - PubMed
  17. Ann Surg. 1908 Dec;48(6):872-5 - PubMed
  18. J Vasc Surg. 2012 Apr;55(4):1072-80 - PubMed
  19. CVIR Endovasc. 2019 May 16;2(1):16 - PubMed
  20. Arch Ital Urol Androl. 2020 Jun 23;92(2): - PubMed
  21. SAGE Open Med Case Rep. 2020 Sep 28;8:2050313X20959219 - PubMed
  22. J Endourol Case Rep. 2020 Jun 04;6(2):73-76 - PubMed
  23. Tech Vasc Interv Radiol. 2009 Sep;12(3):216-21 - PubMed
  24. J Vasc Interv Radiol. 2006 Oct;17(10):1681-5 - PubMed
  25. Cureus. 2020 Jun 25;12(6):e8830 - PubMed
  26. Cardiovasc Revasc Med. 2017 Mar;18(2):145-150 - PubMed
  27. AJR Am J Roentgenol. 2015 May;204(5):W592-8 - PubMed
  28. BMJ Case Rep. 2020 Sep 7;13(9): - PubMed
  29. Urology. 2005 Nov;66(5):990-4 - PubMed
  30. Minim Invasive Ther Allied Technol. 2020 Jul 17;:1-9 - PubMed
  31. Cardiovasc Intervent Radiol. 2013 Aug;36(4):950-6 - PubMed
  32. J Vasc Surg Cases Innov Tech. 2019 Sep 17;5(4):396-401 - PubMed
  33. Radiol Case Rep. 2020 Jul 25;15(9):1714-1717 - PubMed
  34. AJR Am J Roentgenol. 2004 May;182(5):1241-50 - PubMed
  35. IJU Case Rep. 2020 Aug 30;3(6):275-277 - PubMed

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