Mahlknecht Alois, Bizzotto Leonardo, Gamper Christoph, Wieser Anton
Department of Urology, Azienda Sanitaria dell'Alto Adige, Merano.
Arch Ital Urol Androl. 2018 Sep 30;90(3):215-217. doi: 10.4081/aiua.2018.3.215.
Uretero-arterial fistulas are a rare condition. The most frequent clinical sign is hematuria. Since these bleedings occur intermittently, the diagnosis is very difficult. If not discovered, uretero-arterial fistulas involve a very high rate of mortality or even results in loss of kidney function.
The clinical case we describe is an unusual one. After a radical hysterectomy and a subsequent radiotherapy, a hydronephrosis caused by ureteral fibrosis occurred on both sides. Therefore, the patient received bilateral ureteral stents. During a change of the ureteral stents 18 months later, a massive bleeding appeared in the right ureter. Initially, a clear evidence of a fistula was not possible - neither through CT scan nor through selective angiography. There were some indicators of a uretero-arterial fistula, so an endoluminal vessel stent was placed. Subsequently the fistula probably led to an erosion of the vessel stent.
A fistula between the ureter and the iliac artery (UAF) is a rare complication. The increase in known cases during the last years is linked to the possibility of ureteral stenting since 1978. Until now only 140 cases have been described in literature. The mortality rate through UAF has decreased from 69% in 1980 to 7-23% today. Its development can be traced through the pulsation of the artery and the pressure on the ureter. The most important clinical symptom is bleeding. Diagnosis is generally difficult and represents the real problem. The sensitivity of the standard angiography examination is 23- 41%; it can be improved to 63% using the "provocative" method, which means mobilizing the ureteral stent during examination. The therapy in course of the angiography consists of a simultaneous endovascular stent and/or a co-embolisation.
Arterial or uretero-arterial fistulas (UAF) are a rare condition; the diagnosis is very difficult and most of the time the treatment requires a multidisciplinary team.
输尿管-动脉瘘是一种罕见的病症。最常见的临床症状是血尿。由于这些出血是间歇性发生的，诊断非常困难。如果未被发现，输尿管-动脉瘘会导致极高的死亡率，甚至会导致肾功能丧失。
我们所描述的这个临床病例很不寻常。在进行根治性子宫切除术后又接受了放疗，双侧出现了由输尿管纤维化引起的肾积水。因此，患者接受了双侧输尿管支架置入术。18个月后在更换输尿管支架时，右侧输尿管出现大量出血。最初，无论是通过CT扫描还是选择性血管造影，都无法明确瘘管的证据。有一些输尿管-动脉瘘的指标，所以放置了腔内血管支架。随后，瘘管可能导致了血管支架的侵蚀。
输尿管与髂动脉之间的瘘管（UAF）是一种罕见的并发症。近年来已知病例的增加与自1978年以来输尿管支架置入的可能性有关。到目前为止，文献中仅描述了140例。通过UAF导致的死亡率已从1980年的69%降至如今的7%-23%。其发展可以通过动脉的搏动和对输尿管的压力来追踪。最重要的临床症状是出血。诊断通常很困难，这是真正的问题所在。标准血管造影检查的敏感性为23%-41%；使用“激发性”方法（即在检查期间移动输尿管支架）可将其提高到63%。血管造影过程中的治疗包括同时进行腔内支架置入和/或联合栓塞。
动脉或输尿管-动脉瘘（UAF）是一种罕见的病症；诊断非常困难，大多数情况下治疗需要多学科团队。
