A case of iliac-artery-ureteral fistula managed with a combined endoscopic approach.

BACKGROUND

A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac urethral stricture that required the placement of a right ureteral stent. He had attended repeatedly for recurrent ureteral stent replacement, with the most recent replacement having occurred 1 month before the current presentation.

INVESTIGATIONS

Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach.

DIAGNOSIS

An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery.

MANAGEMENT

The patient underwent placement of a covered, self-expandable vascular stent with angioplasty balloon, which resulted in complete exclusion of the pseudoaneurysm and fistula and resolution of the patient's hematuria. A pigtail catheter was placed in the right ureter for 5 days and replaced with a double-J ureteral stent on day 6 after exclusion of the pseudoaneurysm; the patient was discharged from hospital on the same day. Color-Doppler ultrasonography of the right iliac vessels performed 2 months later showed patency of the right iliac artery. The patient's ureteral stent has been replaced every 2 months since his discharge without recurrence of hematuria.