Bergqvist D, Pärsson H, Sherif A
Department of Surgical Sciences, Section of Surgery & Section of Urology, Uppsala, Sweden.
Eur J Vasc Endovasc Surg. 2001 Sep;22(3):191-6. doi: 10.1053/ejvs.2001.1432.
To review published reports on arterio-ureteral fistula.
Literature search.
Eighty cases were identified. Primary fistulas were mainly seen in combination with aortoiliac aneurysmal disease. Secondary fistulas were seen after pelvic cancer surgery, often with radiation, fibrosis and ureteral stenting or after vascular surgery with synthetic grafting. The dominating symptom is massive haematuria, often with circulatory impairment. The clue to a rapid and correct diagnosis is a high degree of suspicion. Most frequently diagnosis has been obtained through angiography or pyelography. When there is a ureteral stent manipulation it will often provoke bleeding and lead to diagnosis. The fistula must be excluded and a vascular reconstruction made. Most frequently this has been obtained through occlusion of the fistula and an extra-anatomic reconstruction (femoro-femoral crossover). Recently stent-grafting has been successfully used but follow-up is short.
Arterio-ureteral fistula is rare and should be suspected in patients with complicated pelvic surgery and massive haematuria, especially where rigid ureteral stents have been placed.
回顾已发表的关于动脉-输尿管瘘的报告。
文献检索。
共确定80例。原发性瘘主要见于合并主髂动脉瘤疾病。继发性瘘见于盆腔癌手术后，常伴有放疗、纤维化和输尿管支架置入，或血管手术后行人工血管移植。主要症状为大量血尿，常伴有循环障碍。快速准确诊断的关键是高度怀疑。最常见的诊断方法是血管造影或肾盂造影。当进行输尿管支架操作时，常引发出血并导致诊断。必须排除瘘并进行血管重建。最常见的是通过瘘口闭塞和解剖外重建（股-股交叉）来实现。最近，支架移植物已成功应用，但随访时间较短。
动脉-输尿管瘘罕见，对于盆腔复杂手术和大量血尿患者，尤其是放置了硬性输尿管支架的患者，应怀疑有动脉-输尿管瘘。
