Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2011 Mar;185(3):945-50. doi: 10.1016/j.juro.2010.10.062. Epub 2011 Jan 19.
Ureteroarterial fistulas can be treated with open vascular or percutaneous arterial stent placement. We compared the long-term outcomes of each treatment.
A single center, retrospective review of ureteroarterial fistulas (1996 to 2008) was performed.
We identified 20 ureteroarterial fistulas in 19 patients. All patients had undergone extirpative surgery with pelvic radiation in 74% and long-term ureteral stents in 84%. At a mean followup of 15.5 months (range 1 to 99) survival was 53%. Of the 70% (14 of 20) treated with percutaneous endovascular iliac artery stenting or embolization, 2 patients later required open vascular graft and 12 were treated with long-term ureteral stenting. Of the 30% (6 of 20) of patients treated with open surgical repair or bypass 2 required bypass revision and/or thrombectomy, and 4 had concomitant ureteral ligation or nephrectomy. Despite undergoing anticoagulation 10 patients (53%) experienced lower extremity morbidity including ulceration, ischemia and amputation. In each treatment group 2 patients had recurrent hemorrhage requiring a secondary procedure, leading to death in 2 for an overall 10% acute mortality rate. Overall noncause specific mortality of ureteroarterial fistulas was 47% and 10% to 20% was related to the fistula or treatment complications.
Endovascular stenting is increasingly used in lieu of open techniques due to the high operative risk and comorbidities in patients with ureteroarterial fistulas. This retrospective review fails to identify a clear advantage for endovascular or open vascular surgical management. Thus, endovascular stenting is preferred in most cases. Regardless of therapy, patients are at risk for recurrent bleeding, lower extremity complications and stent/graft complications. The use of antibiotics and long-term anticoagulant therapy appear prudent but not proved.
输尿管-动脉瘘可通过开放血管或经皮动脉支架置入术进行治疗。我们比较了每种治疗方法的长期疗效。
回顾性分析了 1996 年至 2008 年期间在单一中心就诊的输尿管-动脉瘘患者。
我们共发现 19 例患者的 20 个输尿管-动脉瘘。74%的患者在接受根治性手术时曾接受盆腔放疗，84%的患者长期留置输尿管支架。平均随访时间为 15.5 个月（范围 1 至 99 个月），生存率为 53%。20 例患者中，70%（14 例）采用经皮腔内髂动脉支架置入或栓塞治疗，其中 2 例患者后来需要开放血管移植物治疗，12 例患者需要长期留置输尿管支架。20 例患者中，30%（6 例）采用开放手术修复或旁路治疗，其中 2 例需要旁路修复或血栓切除术，4 例患者同时行输尿管结扎或肾切除术。尽管 10 例患者（53%）接受了抗凝治疗，但仍有 5 例出现下肢并发症，包括溃疡、缺血和截肢。在每种治疗组中，各有 2 例患者因再次出血而需要二次手术，其中 2 例因该并发症死亡，导致总的急性死亡率为 10%。输尿管-动脉瘘的非病因特异性死亡率为 47%，10%至 20%与瘘管或治疗并发症有关。
由于输尿管-动脉瘘患者的手术风险和合并症较高，血管内支架置入术越来越多地替代开放技术。本回顾性研究未能确定血管内或开放血管手术治疗的明显优势。因此，在大多数情况下，血管内支架置入术是首选。无论采用何种治疗方法，患者都有再次出血、下肢并发症和支架/移植物并发症的风险。使用抗生素和长期抗凝治疗似乎是合理的，但尚未得到证实。
