Heers Hendrik, Netsch Christopher, Wilhelm Konrad, Secker Armin, Kurtz Florian, Spachmann Philipp, Viniol Simon, Hofmann Rainer, Hegele Axel
1 Department of Urology and Paediatric Urology, Philipps-Universität Marburg , Marburg, Germany .
2 Department of Urology, Asklepios Klinik Barmbek , Hamburg, Germany .
J Endourol. 2018 Mar;32(3):245-251. doi: 10.1089/end.2017.0819. Epub 2018 Feb 6.
Arterioureteral fistula (AUF) is a rare but potentially life-threatening disease that primarily arises as a long-term complication in oncological patients who have permanent ureteral stenting. The incidence is rising. The objective of this study was to outline the risk factors for management and outcome of AUF in a large individual case series.
Twenty-six AUF cases in 24 patients from six German tertiary referral centers occurring between 2008 and 2016 were identified retrospectively and entered into a dedicated database by using patient notes and out-patient visits.
Of 24 patients, 23 had a history of abdominopelvic surgery for oncological disease, 21/24 had undergone radiotherapy, and 23/24 had long-term ureteral stenting. All cases presented with visible hematuria, 11/26 at the time of a stent exchange. Blood transfusions were required in 92.3%, and intravenous inotropes were needed in 46.2%. Of 26 patients, 11 had flank pain. CT angiogram was positive in 35.7%. Angiography and endovascular fistula repair was performed in 88.5%, and the rest received open surgical repair. Mortality was 7.7%. Endovascular treatment was technically successful in 91.3%, and open surgery was successful in 3/4 cases. Recurrent AUF developed in 3/24 patients. Stent-related complications occurred in 15%. Vascular complications were common. Long-term survival was limited due to progression of the underlying malignant disease.
AUF results in major hemorrhage and warrants time-efficient diagnosis and treatment. Awareness is key. When AUF is considered, interventional angiography should promptly be performed. Fistula detection can be improved by guidewire manipulation. Pre-interventional CT angiogram may be omitted due to low sensitivity. Endovascular repair with stenting and/or coiling is effective and safe.
动静脉瘘（AUF）是一种罕见但可能危及生命的疾病，主要作为长期输尿管支架置入的肿瘤患者的远期并发症出现。其发病率正在上升。本研究的目的是在一个大型单病例系列中概述AUF管理和预后的危险因素。
回顾性确定了2008年至2016年间来自六个德国三级转诊中心的24例患者中的26例AUF病例，并通过使用病历和门诊就诊信息将其录入专用数据库。
24例患者中，23例有因肿瘤疾病进行腹盆腔手术的病史，21/24例接受过放疗，23/24例有长期输尿管支架置入史。所有病例均出现肉眼血尿，11/26例在支架更换时出现。92.3%的患者需要输血，46.2%的患者需要静脉使用血管活性药物。26例患者中，11例有胁腹痛。CT血管造影阳性率为35.7%。88.5%的患者进行了血管造影和血管内瘘修复，其余患者接受了开放手术修复。死亡率为7.7%。血管内治疗技术成功率为91.3%，开放手术在4例中有3例成功。3/24例患者出现复发性AUF。支架相关并发症发生率为15%。血管并发症很常见。由于潜在恶性疾病的进展，长期生存率有限。
AUF导致大出血，需要及时诊断和治疗。意识是关键。当考虑AUF时，应立即进行介入性血管造影。通过导丝操作可提高瘘的检测率。由于敏感性低，术前CT血管造影可省略。支架置入和/或弹簧圈栓塞的血管内修复有效且安全。
