Yoshioka Naoki, Takagi Kensuke, Morita Yasuhiro, Kawase Makoto, Morishima Itsuro
Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Urology, Ogaki Municipal Hospital, Ogaki, Japan.
SAGE Open Med Case Rep. 2020 Sep 28;8:2050313X20959219. doi: 10.1177/2050313X20959219. eCollection 2020.
Arterio-ureteral fistulas are relatively rare, but a potentially life-threatening condition because of the possible massive bleeding. An 82-year-old woman with a history of hysterectomy and irradiation for uterine cancer was treated with ureteric stents for recurrent bilateral ureteral stenosis. During the adjustments of the stent, removing the right ureteric stent immediately resulted in massive hematuria. Computed tomography showed that the right ureter coursed above and seemed to be connected to the right external iliac artery. From the clinical history and computed tomography findings, an arterio-ureteral fistula between the right external iliac artery and right ureter was strongly suspected. The GORE VIABAHN VBX Stent Graft was deployed from the common iliac artery to the external iliac artery via a 7-French femoral system, followed by post-dilatation. The patient did not develop any complications or recurrence of hematuria after the procedure during the 11-month follow-up. The VBX is a useful device, with a low- profile device and a size-adjustable balloon-expandable stent that depended on the individual vessel size for post-dilatation. However, there are several concerns, such as risk of infection, stent thrombosis/stenosis, and chronic outcome while using stent grafts for treatment. Patients with arterio-ureteral fistulas who were treated using stent grafts should be carefully followed up.
动脉输尿管瘘相对少见，但因可能出现大量出血而成为一种潜在的危及生命的病症。一名82岁有子宫切除术及子宫癌放疗史的女性因复发性双侧输尿管狭窄接受输尿管支架治疗。在调整支架过程中，立即移除右侧输尿管支架后出现大量血尿。计算机断层扫描显示右侧输尿管走行于上方，似乎与右髂外动脉相连。根据临床病史和计算机断层扫描结果，强烈怀疑右髂外动脉与右侧输尿管之间存在动脉输尿管瘘。通过7法国的股动脉系统将GORE VIABAHN VBX覆膜支架从髂总动脉部署至髂外动脉，随后进行后扩张。在11个月的随访期间，患者术后未出现任何并发症或血尿复发。VBX是一种有用的装置，它是一种外形小巧的装置，带有一个尺寸可调节的球囊扩张支架，后扩张时可根据个体血管大小进行调整。然而，在使用覆膜支架进行治疗时存在一些问题，如感染风险、支架血栓形成/狭窄以及慢性预后等。使用覆膜支架治疗的动脉输尿管瘘患者应进行仔细的随访。
