TY - JOUR
T1 - Uretero-Iliac artery fistula
T2 - A rare cause of haematuria
AU - Hernandez, Natalia
AU - Desroches, Bethany
AU - Peden, Eric
AU - Satkunasivam, Raj
PY - 2020/9/2
Y1 - 2020/9/2
N2 - A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient's gross haematuria episodes.
AB - A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient's gross haematuria episodes.
KW - haematuria
KW - urinary and genital tract disorders
KW - urological surgery
KW - vascular surgery
UR - http://www.scopus.com/inward/record.url?scp=85090261238&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85090261238&partnerID=8YFLogxK
U2 - 10.1136/bcr-2019-232189
DO - 10.1136/bcr-2019-232189
M3 - Article
C2 - 32878847
AN - SCOPUS:85090261238
VL - 13
JO - BMJ Case Reports
JF - BMJ Case Reports
SN - 1757-790X
IS - 9
M1 - e232189
ER -