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Case Reports
. 2009:2009:326969.
doi: 10.1155/2009/326969. Epub 2009 Nov 15.

Ureteroarterial fistula

D H Kim  1 , A Mahdy, V Mundra, M Berman, G M Ghoniem
Affiliations
Case Reports

Ureteroarterial fistula

D H Kim et al. Case Rep Med. 2009.

Abstract

Ureteral-iliac artery fistula (UIAF) is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.

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Figures

Figure 1
Figure 1
CT scan of pelvis showing rectal mass and double J stent.
Figure 2
Figure 2
Retrograde pyelogram showing fistula between right iliac artery and right ureter. Note the cystoscope tip and ureteral catheter extending up the distal ureter.
Figure 3
Figure 3
Vascular stent spanning the intersection of right iliac artery and ureter.
See this image and copyright information in PMC

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