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Successful endovascular treatment using a covered stent for artery-ureteral fistula after surgery for abdominal aortic aneurysm.

Takase Y, Kodama K, Motoi I - Indian J Urol (2015 Jul-Sep)

Bottom Line: A 63-year-old male who had undergone a Dacron Y-graft placement for an infrarenal aortic aneurysm 3 years earlier, presented with hematuria.Contrast-enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis.Endovascular treatment using a covered stent was performed successfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Toyama City Hospital, 2-1 Imaizumihokubu-chou, Toyama, Toyama 939-8511, Japan.

ABSTRACT
Artery-ureteral fistula (AUF) is a rare condition but there is an increase in the number of reported cases. It is frequently difficult to treat. A 63-year-old male who had undergone a Dacron Y-graft placement for an infrarenal aortic aneurysm 3 years earlier, presented with hematuria. Contrast-enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis. Endovascular treatment using a covered stent was performed successfully.

No MeSH data available.


Related in: MedlinePlus

Arteriography shows no leak of contrast medium to the right ureter. A ureteral stent is located in the right ureter
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Figure 2: Arteriography shows no leak of contrast medium to the right ureter. A ureteral stent is located in the right ureter

Mentions: A 63-year-old male presented with intermittent gross hematuria and anemia. He had undergone a Y-graft surgery for an abdominal aortic aneurysm 3 years earlier. A computed tomography (CT), 1 year after Y-graft surgery revealed that the right ureter had crossed the distal anastomosis of the vascular graft. Two years after the surgery, the ureter was observed to be extrinsically compressed by fibrosis at the site of its crossing over the Y-graft and a ureteral stent was placed at another hospital, 7 months before presentation to us. Cystoscopy revealed hematuria from the right ureteric orifice, suggesting the possibility of AUF. The patient was transferred to our hospital after transfusion of four units of red cell concentrates. Laboratory data showed anemia with a hemoglobin concentration of 9.7 g/dL (normal, 13.5–17.0 g/dL), a hematocrit level of 28.9% (normal, 40–50%), an elevated serum creatinine level of 1.41 mg/dL (normal, 0.4–0.8 mg/dL) and a slightly elevated C-reactive protein concentration of 0.40 mg/dL (normal, 0.00–0.30 mg/dL). He was hemodynamically stable and a urine bacterial culture was negative. At the time of consultation at our hospital, contrast-enhanced CT of the abdomen revealed a possible fistula between the right common iliac artery and the ureter, although no flow of contrast medium to the ureter was detected [Figure 1a]. The CT showed that the process originated at the level of the distal anastomosis of a vascular Y-graft [Figure 1b and c]. Right hydronephrosis with intraureteral blood clots were present. The patient was diagnosed with AUF associated with the Y-graft. An elective endovascular surgery was performed by vascular surgeons following embolization of the right internal iliac artery to prevent endoleak caused by backflow from the right internal iliac artery. Arteriography at the operation detected no leak from the artery to the ureter [Figure 2]. A stent covered by expanded polytetrafluoroethylene (Fluency Plus, Bard Inc., Covington, GA, USA; diameter 10 mm; length, 80 mm) was placed via the right femoral artery. The right ureteral stent was removed after the treatment. Extrinsic obstruction caused by inflammatory fibrotic change was considered to be so dense that it was impossible to treat the ureteral stricture. Neither antiplatelet nor anticoagulation drugs were prescribed. Two weeks after treatment, contrast-enhanced CT showed disappearance of the fistula and improvement of right hydronephrosis. Six months after the endovascular surgery, severe right hydronephrosis was observed with an elevated serum creatinine level of 1.42 mg/dL. Retroperitoneoscopic nephrectomy was performed because we were concerned about recurrence of the fistula. No bleeding from the right residual ureter has been observed.


Successful endovascular treatment using a covered stent for artery-ureteral fistula after surgery for abdominal aortic aneurysm.

Takase Y, Kodama K, Motoi I - Indian J Urol (2015 Jul-Sep)

Arteriography shows no leak of contrast medium to the right ureter. A ureteral stent is located in the right ureter
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495505&req=5

Figure 2: Arteriography shows no leak of contrast medium to the right ureter. A ureteral stent is located in the right ureter
Mentions: A 63-year-old male presented with intermittent gross hematuria and anemia. He had undergone a Y-graft surgery for an abdominal aortic aneurysm 3 years earlier. A computed tomography (CT), 1 year after Y-graft surgery revealed that the right ureter had crossed the distal anastomosis of the vascular graft. Two years after the surgery, the ureter was observed to be extrinsically compressed by fibrosis at the site of its crossing over the Y-graft and a ureteral stent was placed at another hospital, 7 months before presentation to us. Cystoscopy revealed hematuria from the right ureteric orifice, suggesting the possibility of AUF. The patient was transferred to our hospital after transfusion of four units of red cell concentrates. Laboratory data showed anemia with a hemoglobin concentration of 9.7 g/dL (normal, 13.5–17.0 g/dL), a hematocrit level of 28.9% (normal, 40–50%), an elevated serum creatinine level of 1.41 mg/dL (normal, 0.4–0.8 mg/dL) and a slightly elevated C-reactive protein concentration of 0.40 mg/dL (normal, 0.00–0.30 mg/dL). He was hemodynamically stable and a urine bacterial culture was negative. At the time of consultation at our hospital, contrast-enhanced CT of the abdomen revealed a possible fistula between the right common iliac artery and the ureter, although no flow of contrast medium to the ureter was detected [Figure 1a]. The CT showed that the process originated at the level of the distal anastomosis of a vascular Y-graft [Figure 1b and c]. Right hydronephrosis with intraureteral blood clots were present. The patient was diagnosed with AUF associated with the Y-graft. An elective endovascular surgery was performed by vascular surgeons following embolization of the right internal iliac artery to prevent endoleak caused by backflow from the right internal iliac artery. Arteriography at the operation detected no leak from the artery to the ureter [Figure 2]. A stent covered by expanded polytetrafluoroethylene (Fluency Plus, Bard Inc., Covington, GA, USA; diameter 10 mm; length, 80 mm) was placed via the right femoral artery. The right ureteral stent was removed after the treatment. Extrinsic obstruction caused by inflammatory fibrotic change was considered to be so dense that it was impossible to treat the ureteral stricture. Neither antiplatelet nor anticoagulation drugs were prescribed. Two weeks after treatment, contrast-enhanced CT showed disappearance of the fistula and improvement of right hydronephrosis. Six months after the endovascular surgery, severe right hydronephrosis was observed with an elevated serum creatinine level of 1.42 mg/dL. Retroperitoneoscopic nephrectomy was performed because we were concerned about recurrence of the fistula. No bleeding from the right residual ureter has been observed.

Bottom Line: A 63-year-old male who had undergone a Dacron Y-graft placement for an infrarenal aortic aneurysm 3 years earlier, presented with hematuria.Contrast-enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis.Endovascular treatment using a covered stent was performed successfully.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Toyama City Hospital, 2-1 Imaizumihokubu-chou, Toyama, Toyama 939-8511, Japan.

ABSTRACT
Artery-ureteral fistula (AUF) is a rare condition but there is an increase in the number of reported cases. It is frequently difficult to treat. A 63-year-old male who had undergone a Dacron Y-graft placement for an infrarenal aortic aneurysm 3 years earlier, presented with hematuria. Contrast-enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis. Endovascular treatment using a covered stent was performed successfully.

No MeSH data available.


Related in: MedlinePlus