Simon G, Ballanger P, Midy D, Junès F, Baste J C, Boisieras P
Service d'Urologie, Hôpital du Tondu, Bordeaux.
Prog Urol. 1992 Feb;2(1):85-92.
The authors report 3 cases of ilio-ureteric fistulae following aorto-iliac reconstructive surgery. They also review 6 similar cases published in the worldwide literature. All of these cases have in common the appearance of a uretero-arterial fistula several years after the vascular operation on the iliac artery. The postoperative course of iliac thromboendarterectomy appears to be principally responsible, as in the 3 cases presented here, resulting in a pseudoaneurysm over the arteriotomy closure, especially as a patch angioplasty had been performed. This complication is exceptional. The diagnosis must be suspected in the case of profuse haematuria and a suggestive history and should be confirmed, when possible, by intravenous urography, retrograde ureteropyelography, arteriography, or even computed tomography. Treatment is complex and consists of a vascular and urological procedure depending on the degree of urgency and the possibilities of reconstruction.
作者报告了3例主动脉-髂动脉重建手术后发生髂-输尿管瘘的病例。他们还回顾了全球文献中发表的6例类似病例。所有这些病例的共同之处在于,在髂动脉血管手术后数年出现输尿管-动脉瘘。髂动脉血栓内膜切除术的术后过程似乎是主要原因,如此处报告的3例病例,导致动脉切开处闭合处出现假性动脉瘤,尤其是在进行了补片血管成形术的情况下。这种并发症很罕见。对于大量血尿且有提示性病史的病例,必须怀疑有此诊断,如有可能,应通过静脉肾盂造影、逆行输尿管肾盂造影、动脉造影甚至计算机断层扫描来确诊。治疗很复杂,根据紧急程度和重建的可能性,包括血管和泌尿外科手术。