[MO-10] Presentation Awards
Endovascular Treatment of Ureter arterial Fistula using a Covered Stent, Evaluated by Intravascular Ultrasound
Background: Ureteroarterial fistula (UAF) is a rare life-threatening complication of indwelling ureteral stents.
Case presentation: An-84-year-old female with a history of retroperitoneal fibrosis presented with massive gross hematuria and hemorrhagic shock when a ureteral stent was exchanged. Hemostasis was achieved by rapidly inserting the new urinary stent. Computed tomography revealed contact between the left ureter and common iliac artery; therefore, a UAF was suspected. Because it was necessary to exchange the ureter stents every 6 months in order to prevent ureteral infection, endovascular therapy was performed. Angiography showed no blood flow into the ureter; however, a guidewire was advanced from the external iliac artery (EIA) to the left ureter unintentionally. Thus, the diagnosis of UAF was confirmed. Intravascular ultrasound (IVUS) identified the stent in the ureter and its connection to the subintimal lumen of the EIA. After coil embolization of the ipsilateral internal iliac artery, a covered stent was implanted from the CIA to the entry of the subintima in the EIA. The patient had no further episodes of gross hematuria when ureteral stents were exchanged.
Conclusion: We demonstrated a case of UAF, in which IVUS revealed the communication between the ureter and the subintimal lumen in the iliac artery. The fistula could be treated using a covered stent and coil embolization; however, careful follow-up is necessary because the subintimal lumen may be enlarged by the stress of ureter stents.
Case presentation: An-84-year-old female with a history of retroperitoneal fibrosis presented with massive gross hematuria and hemorrhagic shock when a ureteral stent was exchanged. Hemostasis was achieved by rapidly inserting the new urinary stent. Computed tomography revealed contact between the left ureter and common iliac artery; therefore, a UAF was suspected. Because it was necessary to exchange the ureter stents every 6 months in order to prevent ureteral infection, endovascular therapy was performed. Angiography showed no blood flow into the ureter; however, a guidewire was advanced from the external iliac artery (EIA) to the left ureter unintentionally. Thus, the diagnosis of UAF was confirmed. Intravascular ultrasound (IVUS) identified the stent in the ureter and its connection to the subintimal lumen of the EIA. After coil embolization of the ipsilateral internal iliac artery, a covered stent was implanted from the CIA to the entry of the subintima in the EIA. The patient had no further episodes of gross hematuria when ureteral stents were exchanged.
Conclusion: We demonstrated a case of UAF, in which IVUS revealed the communication between the ureter and the subintimal lumen in the iliac artery. The fistula could be treated using a covered stent and coil embolization; however, careful follow-up is necessary because the subintimal lumen may be enlarged by the stress of ureter stents.