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Midterm Results after Open Surgical and Endovascular Management of Arterioureteral Fistula
- Source :
- Annals of Vascular Surgery. 73:280-289
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Background Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. Methods We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up. Results Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery. Discussion Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.
- Subjects :
- Male
Enterocutaneous fistula
medicine.medical_specialty
Time Factors
Urinary Fistula
Fistula
030204 cardiovascular system & hematology
Iliac Artery
030218 nuclear medicine & medical imaging
Blood Vessel Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
Risk Factors
Blood vessel prosthesis
medicine.artery
Humans
Ureteral Diseases
Medicine
Aged
Retrospective Studies
Aged, 80 and over
Vascular Fistula
medicine.diagnostic_test
business.industry
Endovascular Procedures
General Medicine
Perioperative
Digital subtraction angiography
Middle Aged
medicine.disease
Internal iliac artery
Common iliac artery
Blood Vessel Prosthesis
Surgery
Treatment Outcome
Female
Stents
Cardiology and Cardiovascular Medicine
business
Abdominal surgery
Subjects
Details
- ISSN :
- 08905096
- Volume :
- 73
- Database :
- OpenAIRE
- Journal :
- Annals of Vascular Surgery
- Accession number :
- edsair.doi.dedup.....237a660142226412548d60afe0590bba