Endovascular Treatment for Ureteroarterial Fistula in the Anastomotic Site of the Right Prosthetic Leg and Common Iliac Artery after Y-Graft Replacement for Abdominal Aortic Aneurysm
10.4326/jjcvs.42.475
- VernacularTitle:腹部大動脈瘤人工血管置換術後の人工血管脚吻合部に生じた尿管動脈瘻に対する血管内治療の1例
- Author:
Koji Seki
- Publication Type:Journal Article
- Keywords:
ureteroarterial fistula;
covered stent;
endovascular treatment
- From:Japanese Journal of Cardiovascular Surgery
2013;42(6):475-479
- CountryJapan
- Language:Japanese
-
Abstract:
A 63-year-old man underwent Y-graft (16×8 mm Hemashield Gold®) replacement for an abdominal aortic aneurysm in our department in December 2008. In December 2010, the patient was given a diagnosis of right hydronephrosis in another department, for which a right ureteral stent was placed. The condition was resolved and the stent removed in July 2011. Thereafter in October, the patient developed abdominal distension and macroscopic hematuria. Under a diagnosis of recurrent right hydronephrosis, another ureteral stent was placed, though macroscopic hematuria persisted. He was referred to our department, and was admitted for detailed examinations and treatment. Contrast-enhanced computed tomography showed no obvious ureteroarterial fistula or contrast media leakage in the ureter. Because of the history of long-term ureteral stenting and prolonged macroscopic hematuria, regardless of the absence of a hemorrhagic lesion in the urinary tract, an ureteroarterial fistula in the anastomotic site of the right prosthetic leg and right common iliac artery was strongly suspected. There were no findings indicating an infectious complication, thus endovascular treatment was performed for hemostasis from a ureteroarterial fistula. We performed endovascular treatment with coil embolization (TORNADO® 7 mm×3, 5 mm×2) of the right internal iliac artery and a covered stent (fluency plus® 10 mm×80 mm) placement from the right prosthetic leg to the right external iliac artery, after which the hematuria disappeared. Although long-term outcomes following endovascular treatment for ureteroarterial fistula have not been reported, such treatment is considered to be quick and effective, with a low level of invasiveness, thus it should be considered as an effective therapeutic option for such cases in addition to open surgery.
