Interventional Radiology Department, University Hospital Marqués de Valdecilla, Avenida Valdecilla n° 25, 39008, Santander, Cantabria, Spain.
Urology Department, University Hospital Marqués de Valdecilla, Santander, Spain.
Cardiovasc Intervent Radiol. 2022 Dec;45(12):1848-1854. doi: 10.1007/s00270-022-03273-1. Epub 2022 Sep 29.
Arterio-urinary fistulae are a rare but potentially lethal complication that may arise after pelvic surgery, such as radical cystectomy. Historically, open surgery was the gold standard treatment, but currently endovascular treatment has gained prominence.
We report our centre experience in endovascular treatment of cystectomy-related arterial fistulae and review the reported literature on the topic. During the postoperative period of radical cystoprostatectomy five patients presented different ranges of haematuria, and one presented rectal bleeding, four of them with haemodynamic instability. An urgent three-phase computed tomography was performed, showing active bleeding in 2 patients, while the rest of the patients presented indirect signs of fistulae. An angiography was performed, showing contrast extravasation in 60% of the cases and vessel wall irregularity in 40%. Five arteriourinary fistulae and one arterioenteric fistula were urgently treated with a covered stent placement, sealing the site of the fistula in the artery.
Immediate results were satisfactory in all cases; however, one patient died secondary to fistula-related causes 15 days post-treatment. No stent thrombosis or rebleeding have been registered during follow-up. In this review, reported results and complications after covered stent placement are shown, and controversial topics such as antibiotic coverage and antithrombotic treatment after endovascular treatment are also reviewed.
动静脉瘘是一种罕见但潜在致命的并发症，可能发生在盆腔手术后，如根治性膀胱切除术。历史上，开放手术是金标准治疗方法，但目前血管内治疗已崭露头角。
我们报告了我们中心在血管内治疗与膀胱切除术相关的动脉瘘方面的经验，并回顾了该主题的文献。在根治性膀胱前列腺切除术后的恢复期，有 5 名患者出现不同程度的血尿，1 名患者出现直肠出血，其中 4 名患者出现血流动力学不稳定。紧急进行了三期 CT 检查，显示 2 名患者有活动性出血，而其余患者则表现出间接的瘘管迹象。进行了血管造影检查，显示 60%的病例有造影剂外渗，40%的病例有血管壁不规则。5 例动静脉瘘和 1 例动静脉瘘被紧急用覆膜支架治疗，以封闭动脉中的瘘口。
所有病例的即刻结果均令人满意；然而，1 名患者在治疗后 15 天因瘘管相关原因死亡。在随访期间，未发生支架血栓形成或再出血。在本次回顾中，显示了覆膜支架置入后的报告结果和并发症，并回顾了血管内治疗后抗生素覆盖和抗血栓治疗等有争议的话题。
