Division of Interventional Radiology, Department of Radiology, University of Massachusetts Medical School-Baystate, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.
Division of Interventional Radiology, Department of Radiology, University of Massachusetts Medical School-Baystate, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.
J Vasc Interv Radiol. 2019 Dec;30(12):1994-2001. doi: 10.1016/j.jvir.2019.04.029. Epub 2019 Sep 14.
To describe outcomes of transrenal embolization with vascular plugs and ethylene vinyl alcohol (EVOH) in a case series of patients with refractory urinary leak or fistula.
Fifteen ureteral occlusions performed over 53 months in 9 consecutive patients (56% female; mean age 61 y; range, 45-80 y) were reviewed retrospectively. The main indication was palliation for refractory fistula or leak in the setting of malignancy not responding to urine diversion by percutaneous nephrostomy tube or nephroureteral stent. Transrenal ureteral occlusion was performed using EVOH injected between vascular plugs placed distal and proximal to the leak or fistula.
Technical success was 100%. Considerable reduction of urine leak or symptoms (clinical success) was achieved in 64% of ureters after mean follow-up of 105 days (range, 0-632 d). Complete ureteral occlusion on follow-up anterograde nephrostogram (imaging success) was achieved in 60% of ureters after mean follow-up of 139 days (range, 0-643 d). One patient with distal ureterovesical junction-perineal fistula had continued leak despite complete proximal occlusion of ureter owing to retrograde urine reflux from the bladder and was treated with endoscopic injection of intramural calcium hydroxyapatite to the ureteral segment distal to the fistula. Three ureters (33%) in 2 patients with vesicovaginal fistula had recanalization, requiring additional proximal embolization, yielding secondary success rates of 91% (clinical) and 90% (imaging) per ureter. One minor urinary tract infection and no major complications occurred.
Transrenal anterograde ureteral occlusion using EVOH between vascular plugs could be considered a relatively safe and potentially valuable treatment option for refractory ureteral fistulae.
描述在一系列难治性尿漏或瘘管患者中，使用血管塞和乙烯-乙烯醇（EVOH）进行经肾栓塞的结果。
回顾性分析了 9 例连续患者（56%为女性；平均年龄 61 岁；范围为 45-80 岁）在 53 个月内进行的 15 例输尿管阻塞。主要适应证为经皮肾造瘘管或肾输尿管支架不能引流尿液时，姑息治疗恶性肿瘤引起的难治性瘘管或漏尿。通过在漏尿或瘘管的远端和近端放置血管塞之间注射 EVOH 来进行经肾输尿管阻塞。
技术成功率为 100%。在平均随访 105 天（范围为 0-632 天）后，64%的输尿管漏尿或症状（临床成功率）明显减少。在平均随访 139 天（范围为 0-643 天）后，60%的输尿管在随访顺行肾盂造影（影像学成功率）上实现了完全输尿管阻塞。1 例远端输尿管-膀胱交界处-会阴瘘患者尽管近端输尿管完全阻塞，但由于膀胱逆行尿液反流，仍有持续漏尿，并采用内镜将腔内羟磷灰石注射到瘘管远端的输尿管段进行治疗。2 例膀胱阴道瘘患者中有 3 根输尿管（33%）再通，需要进一步近端栓塞，使每根输尿管的二级成功率分别达到 91%（临床）和 90%（影像学）。发生 1 例轻微尿路感染，无严重并发症。
使用血管塞之间的 EVOH 进行经肾顺行输尿管阻塞，可被认为是治疗难治性输尿管瘘的一种相对安全且有潜在价值的治疗选择。
