Omran Safwan, Schäfer Hannah, Kapahnke Sebastian, Müller Verena, Bürger Matthias, Konietschke Frank, Frese Jan Paul Bernhard, Neymeyer Jörg, Greiner Andreas
Clinic of Vascular Surgery, Campus Benjamin Franklin, BerlinCharité - Universitätsmedizin, Berlin, Germany.
Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Vascular. 2021 Oct;29(5):672-681. doi: 10.1177/1708538120970823. Epub 2020 Nov 10.
To report and analyze the indications and results of endovascular and open surgical treatment for uretero-arterial fistula.
We retrospectively reviewed the clinical data of 25 consecutive patients with uretero-arterial fistulas admitted to our hospital from 2011 to 2020. Endpoints were technical success, freedom from open conversion, stent-graft/graft-related complications, and 30-day and one-year mortality.
The study included 25 patients (68% female, = 17) with 27 uretero-arterial fistulas by bilateral pathologies in two patients. The mean age was 61 ± 11 years (range 35-80). The most common predisposing factors for uretero-arterial fistula were history of pelvic operations for malignancy in 21 patients (84%), radiotherapy in 21 patients (84%), previous pelvic vascular bypass in 2 patients (8%), and iliac aneurysms in 2 patients (8%). On average, the period between the primary pelvic surgery and the diagnosis of uretero-arterial fistulas was 46 months (range 7-255). Twenty patients (80%) underwent endovascular treatment of the uretero-arterial fistulas. The primary technical success of the endovascular treatment was 95%, and the freedom from open conversion was 40% at six months and 30% at one year. Thirteen uretero-arterial fistulas (48%) underwent delayed open conversion due to recurrent bleeding in six cases (46%), stent-graft infection in three cases (23%), or pelvic abscess in four cases (31%). Primary open surgery was applied for five (20%) patients. After a mean follow-up of 34 months, early (<30 days) mortality was 8% (2/25), one-year mortality 16% (4/25), and overall mortality was 24% (6/25).
Uretero-arterial fistula is a late complication of prior pelvic surgery, radiation, and indwelling ureteral stents. Endovascular treatment remains an effective and less invasive modality in controlling the related life-threatening arterial bleeding of the uretero-arterial fistula. Open surgical treatment is still required for patients with local sepsis, previously failed endovascular treatment or infected stent-grafts.
报告并分析输尿管动脉瘘的血管内治疗和开放手术治疗的适应证及结果。
我们回顾性分析了2011年至2020年期间连续收治的25例输尿管动脉瘘患者的临床资料。观察终点为技术成功率、无需转为开放手术、支架移植物/移植物相关并发症以及30天和1年死亡率。
该研究纳入了25例患者（68%为女性，共17例），其中2例患者因双侧病变有27处输尿管动脉瘘。平均年龄为61±11岁（范围35 - 80岁）。输尿管动脉瘘最常见的诱发因素是21例（84%）有盆腔恶性肿瘤手术史，21例（84%）接受过放疗，2例（8%）有既往盆腔血管搭桥史，2例（8%）有髂动脉瘤。原发性盆腔手术与输尿管动脉瘘诊断之间的平均间隔时间为46个月（范围7 - 255个月）。20例（80%）患者接受了输尿管动脉瘘的血管内治疗。血管内治疗的原发性技术成功率为95%，6个月时无需转为开放手术的比例为40%，1年时为30%。13处输尿管动脉瘘（48%）因6例（46%）复发出血、3例（23%）支架移植物感染或4例（31%）盆腔脓肿而接受了延迟开放手术。5例（20%）患者接受了原发性开放手术。平均随访34个月后，早期（<30天）死亡率为8%（2/25），1年死亡率为16%（4/25），总死亡率为24%（6/25）。
输尿管动脉瘘是既往盆腔手术、放疗和留置输尿管支架的晚期并发症。血管内治疗在控制输尿管动脉瘘相关的危及生命的动脉出血方面仍然是一种有效且侵入性较小的方式。对于有局部脓毒症、既往血管内治疗失败或支架移植物感染的患者，仍需要进行开放手术治疗。
