Seretis Konstantinos G, Papas Theofanis, Papaioannou Vasileios, Giannakopoulos Nikolaos, Lazaris Andreas M
Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC.
Department of Vascular Surgery, Attikon University Hospital, Athens, GRC.
Cureus. 2024 Jan 30;16(1):e53215. doi: 10.7759/cureus.53215. eCollection 2024 Jan.
Fistula formation between the urinary tract and the arterial system is very rare, and usually involves the ureter and the adjacent iliac vessels. Communication of the ureter with the aorta has been described a few times worldwide, and most of them had a fatal outcome. In our case, a 79-year-old man had a history of total cystectomy for malignancy and diversion of both ureters to a single site in the right hypogastrium with the left one crossing over the aorta. He was admitted elsewhere several times for intermittent hematuria, and four months ago the diagnosis of communication of the left ureter with a mycotic aortic pseudoaneurysm was made. He was then referred to an interventional radiologist who sealed the communication. He was admitted to our hospital four months later in a state of hypovolemic shock and massive hematuria. In lack of information, it seemed to us that he had been treated with endovascular aneurysm repair (EVAR) for uretero-aortic communication, and was experiencing a regression because of endoleak formation. We attempted to treat him as type I endoleak with a proximal extension, and upon failure, with distal extensions, but finally we had to 'build' the entire previous graft from the inside to achieve hemodynamic stability. Our patient remained stable, without endoleak on the post-intervention computed tomography angiography (CTA). Post-operatively, we discovered that the initial operation was the formation of a bifurcated graft with multiple bare stents and coil embolization through them. This was done in an attempt to avoid material infection by the mycotic aneurysm. This is an example of a case where 'things got rough' in a lack of information on patients' medical records. Maybe the time has come to adopt the concept of implanting microchips into humans which would enable doctors to access their medical records. This will only serve as a tool for the benefit of the suffering patients, especially when we are dealing with life-threatening situations with no time to be lost.
尿路与动脉系统之间形成瘘管极为罕见，通常累及输尿管及相邻的髂血管。输尿管与主动脉相通在全球范围内仅有少数病例报道，且多数预后不佳。在我们的病例中，一名79岁男性曾因恶性肿瘤接受全膀胱切除术，并将双侧输尿管改道至右下腹同一部位，其中左侧输尿管跨过主动脉。他曾多次因间歇性血尿在其他医院就诊，4个月前诊断为左输尿管与霉菌性主动脉假性动脉瘤相通。随后他被转诊至介入放射科医生处，后者封堵了相通部位。4个月后，他因低血容量性休克和大量血尿入住我院。由于信息不足，我们推测他之前接受了血管内动脉瘤修复术（EVAR）治疗输尿管-主动脉相通，现因内漏形成而病情恶化。我们尝试通过近端延长来治疗I型内漏，失败后又尝试远端延长，但最终不得不从内部“重建”整个先前的移植物以实现血流动力学稳定。我们的患者病情稳定，术后计算机断层扫描血管造影（CTA）显示无内漏。术后，我们发现最初的手术是构建一个带有多个裸支架的分叉移植物，并通过它们进行弹簧圈栓塞。这样做是为了避免霉菌性动脉瘤的材料感染。这是一个因缺乏患者病历信息而导致“情况变得棘手”的案例。或许现在是时候采用将微芯片植入人体的概念了，这将使医生能够获取患者的病历。这只会成为造福受苦患者的工具，尤其是在我们处理危及生命的情况且刻不容缓的时候。
