van den Bergh Roderick C N, Moll Frans L, de Vries Jean-Paul P M, Yeung Kakkhee K, Lock Tycho M T W
University Medical Center, Utrecht, The Netherlands.
J Urol. 2008 Feb;179(2):578-81. doi: 10.1016/j.juro.2007.09.087. Epub 2007 Dec 21.
We provide insight into the presentation, diagnostics, treatment, and accompanying clinical difficulties and complications of an arterio-ureteral fistula and add 11 patients with arterio-ureteral fistula to the 90 described in the literature.
A retrospective search was done for confirmed cases of arterio-ureteral fistula that were treated at 3 medical centers.
A total of 11 cases of arterio-ureteral fistula were reviewed from 1980 to 2006. A history of major abdominal surgery had an essential role in 10 of the 11 cases, especially vascular intervention in 8. All patients presented with varying manifestations of hematuria. Ureteral contrast studies and nonprovocative angiography provided the most valuable diagnostic information with all 5 and 3 of 5 showing positive results, respectively. In 4 of 11 patients (36%) the diagnosis of arterio-ureteral fistula was only made during laparotomy. Ten patients were treated with a classic open surgical approach (vascular and urological) and in 1 endovascular stents were inserted. Two of 11 patients (18%) needed acute surgical intervention because of hemodynamic instability. The in hospital mortality rate was 9%. At a mean followup of 17 months 3 other patients (27%) had died of causes unrelated to the arterio-ureteral fistula.
The diagnosis of arterio-ureteral fistula should be considered in patients with persistent hematuria who have a history of major abdominal vascular surgery even when diagnostic test results are negative for a fistula, because in 36% of our patients the diagnosis could only be made at operation. The in hospital morbidity and mortality rates are considerable and, therefore, a timely diagnosis and elective multidisciplinary treatment are preferred.
我们深入探讨动静脉瘘的临床表现、诊断、治疗以及伴随的临床困难和并发症，并在文献报道的90例基础上增加11例动静脉瘘患者。
对3个医疗中心治疗的确诊动静脉瘘病例进行回顾性研究。
1980年至2006年共回顾了11例动静脉瘘病例。11例中有10例既往有腹部大手术史，其中8例有血管介入史。所有患者均有不同程度的血尿表现。输尿管造影和非激发性血管造影提供了最有价值的诊断信息，分别有5例和5例中的3例显示阳性结果。11例患者中有4例（36%）在剖腹手术时才确诊为动静脉瘘。10例患者采用经典的开放手术方法（血管和泌尿外科联合）治疗，1例患者植入了血管内支架。11例患者中有2例（18%）因血流动力学不稳定需要急诊手术干预。住院死亡率为9%。平均随访17个月时，另外3例患者（27%）死于与动静脉瘘无关的原因。
对于有腹部大血管手术史且持续血尿的患者，即使瘘管的诊断检查结果为阴性，也应考虑动静脉瘘的诊断，因为我们的患者中有36%仅在手术时才能确诊。住院发病率和死亡率较高，因此，及时诊断和选择性多学科治疗更为可取。
