Midterm Results after Open Surgical and Endovascular Management of Arterioureteral Fistula
| Autor: | Wilma Schierling, Piotr M. Kasprzak, Karin Pfister, Stefan Denzinger, Kyriakos Oikonomou, Georgios Sachsamanis |
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| Rok vydání: | 2021 |
| Předmět: |
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 |
| Zdroj: | Annals of Vascular Surgery. 73:280-289 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2020.11.014 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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