Rafael D. Malgor, MD, Gustavo S. Oderich, MD, James C

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Presentation transcript:

Evolution from open surgical to endovascular treatment of ureteral-iliac artery fistula Rafael D. Malgor, MD, Gustavo S. Oderich, MD, James C. Andrews, MD, Michael McKusick, MD, Manju Kalra, MBBS, Sanjay Misra, MD, Peter Gloviczki, MD, Thomas C. Bower, MD Journal of Vascular Surgery Volume 55, Issue 4, Pages 1072-1080 (April 2012) DOI: 10.1016/j.jvs.2011.11.043 Copyright © 2012 Terms and Conditions

Fig 1 Technique of endovascular treatment of ureteral-iliac artery fistula (UIAF). Right iliac angiography reveals no obvious extravasation of contrast in the crossing point of the ureteral stent (A, black arrow), but selective catheterization of the fistulous communication demonstrates contrast extravasation into the right ureter and ureteral stent (B, black arrow). The patient was treated with covered balloon-expandable stent (C), which was deployed in the external iliac artery (D, black arrow) preserving flow into the internal iliac artery. Journal of Vascular Surgery 2012 55, 1072-1080DOI: (10.1016/j.jvs.2011.11.043) Copyright © 2012 Terms and Conditions

Fig 2 Patient with complex ureteral-iliac artery fistula (UIAF) with erosion into the rectum presented with massive hematuria and exsanguinating hemorrhage 3 months after endovascular treatment by self-expandable stent graft at other institution. Left iliac angiography (A) demonstrates disruption of the left iliac artery and stent graft with extravasation of contrast into the retroperitoneum. A catheter was used to traverse the disrupted stent (A, black arrow). The patient was treated by placement of a self-expandable stent graft (B) as a bridge to definitive repair. Contrast enema (C) also confirmed communication of the rectum with the complex abscess in the retroperitoneum space. The patient subsequently underwent staged right-to-left femoral crossover bypass, followed by abdominal exploration, resection of the left external iliac artery, ureteral conduit, colectomy, and colostomy. Journal of Vascular Surgery 2012 55, 1072-1080DOI: (10.1016/j.jvs.2011.11.043) Copyright © 2012 Terms and Conditions

Fig 3 Kaplan-Meier survival estimates of freedom from hematuria in 20 patients treated for ureteral-iliac artery fistulas (UIAFs). Journal of Vascular Surgery 2012 55, 1072-1080DOI: (10.1016/j.jvs.2011.11.043) Copyright © 2012 Terms and Conditions

Fig 4 Kaplan-Meier survival estimates of primary (A) and secondary (B) patency rates in 20 patients treated for ureteral-iliac artery fistulas (UIAFs) with endovascular stent grafts. Journal of Vascular Surgery 2012 55, 1072-1080DOI: (10.1016/j.jvs.2011.11.043) Copyright © 2012 Terms and Conditions

Fig 5 Kaplan-Meier patient survival estimates in patients treated for ureteral-iliac artery fistula (UIAF) and for control patients from the general population of the State of Minnesota (MN). Journal of Vascular Surgery 2012 55, 1072-1080DOI: (10.1016/j.jvs.2011.11.043) Copyright © 2012 Terms and Conditions

Fig 6 Proposed diagnostic and treatment algorithm for dealing with ureteral-iliac artery fistula (UIAF). Journal of Vascular Surgery 2012 55, 1072-1080DOI: (10.1016/j.jvs.2011.11.043) Copyright © 2012 Terms and Conditions