Sachsamanis Georgios, Pfister Karin, Kasprzak Piotr M, Schierling Wilma, Denzinger Stefan, Oikonomou Kyriakos
Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
Ann Vasc Surg. 2021 May;73:280-289. doi: 10.1016/j.avsg.2020.11.014. Epub 2020 Dec 24.
Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential.
We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up.
Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery.
Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.
动脉输尿管瘘是指髂动脉与输尿管之间异常的瘘管连接。它常与盆腔恶性肿瘤、腹部手术及放疗相关。由于这是一种潜在的危及生命的疾病，及时诊断和治疗至关重要。
我们对2013年1月至2019年3月在一家单一血管机构接受动脉输尿管瘘治疗的患者进行了回顾性分析。术前评估包括体格检查、实验室检查及病史采集，通过计算机断层血管造影、数字减影血管造影或输尿管镜检查确诊。分析的参数包括围手术期死亡率和发病率以及中期随访期间的治疗持久性。
本研究纳入了9例患有10处动脉输尿管瘘的患者。肉眼血尿是主要的临床表现症状，2例患者因失血性休克入院。6例患者接受了血管内治疗。4例患者在髂总动脉内单一支架型人工血管置入，1例联合髂内动脉封堵。1例患者植入了髂分支装置，而另1例患者通过髂内动脉弹簧圈栓塞足以治疗瘘管。3例患者接受了开放手术修复。围手术期死亡率为零；1例患者因浅表伤口感染住院时间延长。血管内修复术后随访期间，3例患者出现复发性血尿和支架型人工血管感染，均通过开放手术治疗，无进一步并发症。1例患者在随访期间开放修复后发生肠皮肤瘘，需要再次手术。
动脉输尿管瘘是一种具有挑战性的临床情况，需要及时诊断和治疗。对于已存在血管重建或明显感染的病例，开放手术仍是首选治疗方法。血管内技术为合并症严重的患者或出现急性、危及生命出血的患者提供了可行的解决方案。无论采用何种治疗方式，由于再次干预的发生率较高，都需要进行严格的随访。
