Fujioka Hayato, Yamazaki Hidenori, Imamura Teruhiko, Koike Tsutomu, Arisawa Yu, Murai Sayaka, Nishiyama Naotaka, Kitamura Hiroshi, Naruto Norihito, Nagao Kanetsugu, Yamashita Shigeyuki, Kinugawa Koichiro
The Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
Department of Urology, University of Toyama, Toyama, 930-0194, Japan.
CEN Case Rep. 2025 Feb;14(1):16-23. doi: 10.1007/s13730-024-00895-x. Epub 2024 Jun 5.
Arterioureteral fistula represents a rare yet consequential urological complication characterized by persistent and refractory urinary tract bleeding. Its emergence typically involves aneurysm formation, presenting significant life-threatening implications. Nonetheless, its infrequency contributes to sparse documentation of incidences in post-kidney transplant recipients, thereby fostering numerous uncertainties concerning associated risks. A 67-year-old male patient, afflicted with end-stage renal failure and a history of urinary tract infection, underwent a living donor kidney transplant four months prior. Complications involving intraoperative bleeding necessitated the prolonged placement of a ureteral stent post-surgery. Subsequently, he experienced an abrupt onset of ureteral bleeding accompanied by shock, later diagnosed via contrast-enhanced computed tomography as pseudo-aneurysm formation in the right external iliac artery proximal to the allograft renal artery anastomosis, in conjunction with a fistula formation involving the donor ureter. Despite repeated attempts at intervention with covered stenting, the aneurysm persisted and proved refractory to resolution. Tragically, seven months later, the aneurysm ruptured, culminating in the demise of the patient. Our report details a case involving perioperative complications following kidney transplantation, persistent bacteriuria, and prolonged ureteral stenting, ultimately leading to the development of an arterioureteral fistula. Despite undergoing stent graft insertion as an intervention, the patient succumbed to aneurysm rupture associated with the arterioureteral fistula. This condition, though rare, can prove fatal following kidney transplantation. Consequently, future endeavors in this domain necessitate an emphasis on optimizing risk management, refining diagnostic approaches, and devising more effective therapeutic strategies to mitigate such complications.
动静脉瘘是一种罕见但后果严重的泌尿系统并发症，其特征为持续性难治性尿路出血。它的出现通常涉及动脉瘤形成，具有重大的生命威胁。然而，其罕见性导致肾移植受者中发病率的文献记载稀少，从而引发了许多关于相关风险的不确定性。一名67岁男性患者，患有终末期肾衰竭且有尿路感染病史，四个月前接受了活体供肾移植。术中出血并发症导致术后输尿管支架长时间留置。随后，他突然出现输尿管出血并伴有休克，后来通过增强计算机断层扫描诊断为在移植肾动脉吻合口近端的右髂外动脉形成假性动脉瘤，同时伴有供体输尿管瘘形成。尽管多次尝试采用覆膜支架进行干预，但动脉瘤持续存在且难以解决。不幸的是，七个月后，动脉瘤破裂，导致患者死亡。我们的报告详细描述了一例肾移植术后围手术期并发症、持续性菌尿和输尿管支架长时间留置的病例，最终导致动静脉瘘的发生。尽管进行了支架植入作为干预措施，但患者死于与动静脉瘘相关的动脉瘤破裂。这种情况虽然罕见，但在肾移植后可能是致命的。因此，该领域未来的努力需要强调优化风险管理、改进诊断方法以及制定更有效的治疗策略以减轻此类并发症。
