Kim D H, Mahdy A, Mundra V, Berman M, Ghoniem G M
Department of Urology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd. Weston, FL 33331, USA.
Case Rep Med. 2009;2009:326969. doi: 10.1155/2009/326969. Epub 2009 Nov 15.
Ureteral-iliac artery fistula (UIAF) is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.
输尿管-髂动脉瘘（UIAF）是一种罕见的、危及生命的血尿病因。其发病率的增加归因于输尿管支架使用的增多。一名68岁女性出现肉眼血尿。她曾因直肠癌接受低位前切除术并留置了输尿管支架。腹部和盆腔CT显示盆腔有一个巨大的复发性肿块以及一个留置支架。患者接受了膀胱镜检查，结果显示膀胱正常。取出支架后，发现输尿管口有活跃出血。进行了顺行肾盂造影，结果显示为输尿管-髂动脉瘘。进行了血管造影并放置了覆膜支架。有多种治疗选择。所有治疗都必须考虑动脉和输尿管方面的处理。动脉方面可通过一期开放修复、带解剖外血管重建的栓塞或血管内支架置入来处理。输尿管可通过肾输尿管切除术、输尿管重建、放置肾造瘘管或输尿管支架来处理。鉴于其微创性，我们认为血管内支架置入应是首选的治疗选择，因为它在保留远端血流的同时还能纠正出血源。
