Vandersteen D R, Saxon R R, Fuchs E, Keller F S, Taylor L M, Barry J M
Division of Urology, Oregon Health Sciences University, Portland, USA.
J Urol. 1997 Sep;158(3 Pt 1):754-8.
We describe an effective multidisciplinary approach to the diagnosis and management of ureteroarterial fistulas that reduces morbidity and mortality.
Five ureteroarterial fistulas in 4 patients were studied with standard and provocative arteriography (arteriography combined with ureteral manipulation). After establishing the diagnosis, each lesion was treated with percutaneous embolic occlusion of the common iliac artery followed by extraanatomic arterial bypass grafting. All patients had chronic ureteral stenting, prior pelvic irradiation, prior pelvic surgery and intrapelvic malignancy, and all fistulas presented with urinary tract hemorrhage.
Standard arteriography was nondiagnostic but provocative arteriography demonstrated the fistula in each case. Successful embolization of the common iliac artery followed by extraanatomic arterial bypass grafting precluded the need for laparotomy and preserved ipsilateral renal function.
Provocative arteriography followed by arteriographic common iliac artery embolization and extraanatomic bypass grafting was successful for the diagnosis and treatment of ureteroarterial fistulas. There was no mortality, limb loss or renal loss.
我们描述一种有效的多学科方法，用于输尿管动脉瘘的诊断和管理，以降低发病率和死亡率。
对4例患者的5处输尿管动脉瘘进行了标准和激发性动脉造影（动脉造影结合输尿管操作）研究。确诊后，对每个病变进行经皮髂总动脉栓塞闭塞，随后进行解剖外动脉旁路移植术。所有患者均有慢性输尿管支架置入史、既往盆腔放疗史、既往盆腔手术史和盆腔内恶性肿瘤，所有瘘均表现为尿路出血。
标准动脉造影未能确诊，但激发性动脉造影在每例中均显示了瘘。成功栓塞髂总动脉并随后进行解剖外动脉旁路移植术避免了剖腹手术的需要，并保留了同侧肾功能。
激发性动脉造影后行动脉造影髂总动脉栓塞和解剖外旁路移植术成功用于输尿管动脉瘘的诊断和治疗。无死亡、肢体缺失或肾功能丧失情况。
