Ureteroarterial Fistula: A Diagnosis Which Is Not Always Black and White

Abstract

Ureteroiliac artery fistulas are a rare, life-threatening condition that requires a high index of suspicion for prompt diagnosis. Presurgical diagnosis is challenging as this condition can lie hidden despite advanced imaging modalities. We present two cases of patients presenting with gross hematuria and exsanguination in the setting of a ureteroiliac artery fistula. These cases highlight the difficulties in timely diagnosis and treatment in a multidisciplinary team.

Figure 1

Left nephrostogram with contrast noted extravasating through the fistula tract from the left ureter into the left iliac artery.

Figure 2

Arteriogram following endograft placement with no contrast exiting the arterial system. Left nephroureteral stent is noted traversing the location of graft placement highlighting the region of fistula formation.

Figure 3

Left ureter raised with left bipolar forceps and small Hem-o-lok clip controlling the divided smaller vascular connection with a laparoscopic Satinsky clamp placed on the left external iliac artery proximal to the ureteroiliac fistula.