Geevarghese Ruben, Gupta Neil
Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, United Kingdom.
J Endourol Case Rep. 2020 Jun 4;6(2):73-76. doi: 10.1089/cren.2019.0095. eCollection 2020.
Renal transplantation is a common surgical intervention for end-stage renal failure. Arterioureteral fistula (AUF) is a rare but important cause of gross hematuria that can be difficult to diagnose and associated with high morbidity and mortality. We report a case of a 68-year-old woman presenting with acute or chronic hematuria on a background of two renal transplants. Her initial renal transplant failed 8 years after the initial surgery but was left . Her hematuria was initially investigated with cystoscopy; however, this did not identify a bleeding point and during which the patient became hemodynamically unstable. After transfer to the interventional radiology suite, the patient underwent fluoroscopic angiography. This did not immediately demonstrate a bleeding point. However, a CT angiogram was subsequently undertaken that identified an AUF between the native left ureter and the failed transplant renal artery. This was effectively managed with placement of a covered endovascular stent. Owing to efficacy and safety, endovascular management is an attractive option for treatment of AUF. Furthermore, endovascular treatment may provide a transplant sparing option, in those with functioning organs.
肾移植是终末期肾衰竭常见的外科干预措施。动静脉瘘（AUF）是肉眼血尿的一种罕见但重要的病因，可能难以诊断，且与高发病率和死亡率相关。我们报告一例68岁女性病例，该患者在接受两次肾移植后出现急性或慢性血尿。她的首次肾移植在初次手术后8年失败，但移植肾被保留。她的血尿最初通过膀胱镜检查进行评估；然而，未发现出血点，且在此期间患者血流动力学不稳定。转至介入放射科后，患者接受了透视血管造影。当时未立即显示出血点。然而，随后进行的CT血管造影发现左输尿管与失败移植肾动脉之间存在动静脉瘘。通过放置覆膜血管内支架有效解决了该问题。鉴于其有效性和安全性，血管内治疗是治疗动静脉瘘的一个有吸引力的选择。此外，对于器官功能正常的患者，血管内治疗可能提供一种保留移植肾的选择。
