Arterial-Ureteral Fistula: Case Study with Review of Published Reports Cornelius M. D y k e , MD, F r a z i e r F o r t e n b e r r y , MD, P. G a r y K a t z , M D , Michael Sobel, MD, F A C S , Richmond, Virginia
Arterial-ureteral fistula, a rare cause of gross hematuria, may be associated with life-threatening hemorrhage if not rapidly diagnosed and treated. Recently, a patient at the Hunter H. McGuire Veterans Administration Medical Center developed an arterial-ureteral fistula at the site of the confluence of the external iliac artery and a superior mesenteric artery bypass graft. Review of the world's literature revealed 31 additional reported cases of arterial-ureteral fistulas [1-31]. This current case is only the second one reported in which the diagnosis was made with arteriography. Several common features of arterial-ureteral fistulas were present in this case: a history of ureteral obstruction and urinary tract infections, upper urinary tract disease, and previous vascular surgery. The condition is usually associated with either prior upper urinary tract instrumentation or vascular surgery, and an antecedent period of intermittent hematuria, followed by life-threatening hematuria, is common. A high index of suspicion and early surgical intervention are required for successful management. The major surgical challenges are to establish unobstructed urinary drainage and restore vascular continuity. Exclusion of prosthetic material from potentially infected areas is mandatory. (Ann Vasc Surg 1991;5:282285). KEY WORDS: graft.
Fistula; arterial-ureteral fistula; hematuria; iliac-mesenteric artery
CASE REPORT A 64-year-old man, a T10 paraplegic, presented to the emergency room with a four day history of gross hematuria. His vascular history was significant for repair of an abdominal aortic aneurysm with a dacron tube graft 20 years prior to admission. In 1976, he underwent mesenteric revascularization with a synthetic conduit placed retrograde from his right external iliac artery to the superior mesenteric artery. In addition, his right kidney was revascularized with a saphenous vein conduit from the fight external iliac artery (originat-
From the Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Hunter H. McGuire Veterans Administration Medical Center, Richmond, Virginia. Reprint requests: Michael Sobel, MD, Box 108 MCV Station, Medical College of Virginia, Richmond, Virginia 23298.
ing distal to the mesenteric bypass graft). The original indications for mesenteric and fight renal revascularization are not known. His urologic history was significant for 25 years of paraplegia with bladder management by indwelling catheterization. He had a chronic fight double-J ureteral stent f o r treatment of a ureteral stricture and hydronephrosis. Renal blood flow scans documented decreased right renal blood flow with normal left-sided blood flow. Serum creatinine on admission was 1.6 mg/dl with a blood urea nitrogen of 26 mg/dl. Further evalUation with cystoscopy and retrograde pyelogram revealed blood emanating from the right ureteral stent and proximal right ureteral and pelvic obstruction with multiple filling defects. A right percutaneous nephrostomy was performed, followed by nephroscopy. Upon stent removal, vigorous bleeding was observed precluding adequate visualization of the source through the nephroscope. No hemodynamic instability occurred
282
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retrograde mesenteric graft was well incorporated into the surrounding tissues more cephalad. Direct arterial pressure measurements of the native superior mesenteric artery were normal. To solve the difficult problem of the potentially infected synthetic material, the Dacron graft was dissected free cephalad from the pseudoaneurysm and resected. The portion of the graft anastomosed to the superior mesenteric artery was oversewn and covered with autologous tissue before the pseudoaneurysm was entered. After unroofing the pseudoaneurysm/fistula, an autologous vein patch was used to repair the external iliac artery because it could not be closed primarily. The origin of the iliac artery-renal saphenous vein graft was distal to the fistula and revision of the renal bypass graft unnecessary. Due to the extent of ureteral involvement, the ureter was ligated proximally and distally. A nephrostomy tube was left intact for long-term urinary drainage. Postoperatively, the patient had an uneventful course with no further episodes of bleeding. Intraoperative bacterial cultures were sterile, although pseudomonas species were cultured from his urine. He was maintained on antibiotics for two weeks. His renal function was unchanged postoperatively; serum creatinine was 1.5 mg/dl at discharge. Up to 18 months postoperatively, the patient's right lower extremity blood flow was uncompromised and no problems relating to the repair of the fistula had developed. His renal function had not deteriorated.
DISCUSSION
Fig. 1. Arteriogram reveals saphenous vein-renal artery bypass graft (hollow arrow) along with external lilac artery (large solid arrow). External lilac artery-right ureteral fistula is evident at site of pseudoaneurysm, along with extravasation of contrast into dilated, clot-filled ureter (small solid arrow). Percutaneous nephrostomy tube is visualized laterally.
and the patient was taken to the surgical intensive care unit for observation. Within 24 hours, the nephrostomy tube drainage cleared. On the third day after stent removal the patient had a second episode of massive hematuria with hemodynamic instability. Resuscitation and blood transfusion were begun and an abdominal aortic arteriogram performed. The arteriogram revealed a right external iliac artery pseudoaneurysm at the confluence of the artery with the ureter, with extravasation of contrast into the clot-filled ureter (Fig. 1). The patient was explored transabdominally on an emergency basis. An arterial-ureteral fistula was identified at the anastomosis of the superior mesenteric artery bypass graft to the external iliac artery. This anastomosis was partially dehisced and the pseudoaneurysm was in direct continuity with the infected urinary stream. The Dacron
This review represents a large group of patients gathered from the world's literature with arterialupper urinary tract fistula. Prior to fistula formation, all but three patients had previous vascular surgery or significant upper urinary tract disease requiring stenting of the ureter. In two of the exceptions, penetrating trauma was the cause of fistula formation [10,22], while a congenital arteriovenous malformation of the internal iliac artery and vein was the etiologic factor in the third [12]. Retroperitoneal fibrosis from external beam radiation therapy and subsequent ureteral obstruction played a role in fistula formation in two other patients [4,1 I]. The current patient had a typical history of longstanding ureteral obstruction which developed after reconstructive vascular surgery. Ninety percent of the patients in this review had evidence of ipsilateral ureteral obstruction at the time of fistula formation. In addition, two-thirds of the patients had indwelling ureteral catheters at the time of presentation. First described by J a c o b s o n [32], the potential for ureteral obstruction after aortic surgery is well recognized. Postoperative hydronephrosis has been estimated to occur in 2 to 14% of patients following aortic reconstruction [33-36]. The potentially serious effect of ureteral obstruction on vascular grafts was first recognized by Shaw and Baue in 1963 [37], with subsequent studies reporting a 55 to 89% incidence of graft complications associated with postoperative hydronephrosis [38,39]. These
284
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ARTERIAL-URETERAL FISTULA
complications are typically infectious in nature and include anastomotic aneurysm formation, graft infection and thrombosis, and aorto-enteric fistulae [40]. Although arterial-ureteral fistula is a much rarer complication of postoperative ureteral obstruction, gross hematuria in this setting should alert the clinician to the possibility of arterialurinary tract fistula. In 15 of the 22 cases in which the diagnostic evaluation was detailed, the diagnosis of arterialureteral fistula was not made until the time of operation. In two cases the diagnosis was made at autopsy [13,20]. The current patient is the second case reported in which the diagnosis was made preoperatively with an arteriogram [31]. Three patients were diagnosed by retrograde ureterogram [4,7,19]. Cystoscopy was only helpful in lateralizing the bleeding to the involved ureter. Ureteroscopy and nephroscopy may be helpful in further localizing the site of hemorrhage. Seventy-three percent (16/22) of the patients in whom the clinical history was detailed were hypotensive upon presentation, demonstrating the severity of the hematuria. Seventy-seven percent (17/ 22) required blood transfusion. Twenty-one of 27 patients were treated surgically; three deaths in the perioperative period were reported for a surgical mortality of 14%. Six patients had nonoperative therapy with a mortality of 83%. The surviving patient treated nonsurgically had arteriographic embolization of the right common iliac artery after the diagnosis was made by retrograde ureterogram [4]. Goals in the surgical management of arterialureteral fistula include; (1) control of hemorrhage and restoration of vascular continuity; (2) provision of adequate urinary drainage; and (3) removal and exclusion of potentially infected prosthetic material. Renal salvage should also be attempted; this was possible in 67% of patients in this review. Management of the involved ureter is dependent on the location and extent of ureteral involvement and may include ureterectomy, excision and bladder reimplantation, ureterostomy, uretero-ureterostomy, and excision and primary repair over a double-J stent [7,11,12,16,31]. Vascular control of the arterial-ureteral fistula required ligation of the internal or common iliac artery in 48% of patients (10/21). All of these patients required revascularization after ligation. In patients with prosthetic arterial bypass grafts, the potentially infected fistula creates another obstacle in management. Protection and exclusion of uninfected and uninvolved segments of the bypass graft is important, as is specific postoperative antibiotic therapy. The optimal duration of antibiotic therapy is not known and should be dictated by the presence or absence of prosthetic material and gross contamination. Restoration of vascular integrity may be obtained with the use of autologous tissue f o r
vascular repair of the fistula or excision of potentially infected prosthetic material and extraanatomic bypass.
REFERENCES 1. AHLBORN TH, BIRKHOFF JD, NOWYGROD R. Common iliac artery-ureteral fistula: case report and literature review. J Vasc Surg 1986;3:155-158. 2. NICITA G, LUNGHI F, DILIGENTI LM, et al. Arteriovesical fistula after ureterolithotomy: a case report and review of the literature. J Urol 1978 ;120:370-371. 3. SHULTZ ML, EWING DD, LOVETT VF. Fistula between lilac aneurysm and distal stump of ureter with hematuria: a case report. J Urol 1974;112:585-586. 4. TOOLIN E, POLLACK HM, MC LEAN GK, et al. Ureteroarterial fistula: a case report. J Urol 1984;132:553-554. 5. RENNICK JM, LINK DP, PALMER JM. Spontaneous rupture of an iliac artery aneurysm into a ureter: a case report and review of the literature. J Urol 1976;116:111-113. 6. KAR A, ANGWAFO FF, JHUNJHUNWALA JS. Ureteroarterial and ureterosigmoid fistula associated with polyethylene indwelling ureteral stents. J Urol 1984;132:755-757. 7. WHEATLEY JK, ANSLEY JD, SMITH RB, et al. Ureteroarterial fistula. Urology 1981;18:498-502. 8. ADAMS PS, Jr. Iliac artery ureteral fistula developing after dilatation and stent placement. Radiology 1984;153:647-648. 9. BAUM ML, BAUM RD, PLAINE L, et al. Computed tomography in the diagnosis of fistula between the ureter and iliac artery. J Comput Assist Tomogr 1987;11(4):719-721. 10. ROUS SN, ANDRONACO JT. Post-traumatic aneurysm of the iliac artery with rupture directly into bladder: a case report and review of the literature. J Urol 1972;108:722-723. 11. REINER RJ, CONWAY GF, THRELKELD R. Ureteroarterial fistula. J Urol 1975;113:24-25. 12. SHARMA SK, GOSWAMI AK, SHARMA GP, et al. Congenital iliac arteriovenous malformation: a cause of massive hematuria and ureteral obstruction. J Urol 1988;139:355356. 13. SHETTY SD, READ JR, NEWLING DWW. Ureteroarterial fistula. Br J Urol 1988;62(4):382-383. 14. GOLDBERG PL, HENDRY WF, WHITFIELD HN, et al. A case of uretero-arterial fistula. Br J Urol 1981;54:196. 15. JOOST J, BARTSCH G, WEIMANN S, et al. Ilioureteric fistula. Br J Urol 1981;53:477. 16. BEARD JD, SOMERVILLE PG, WARD JP, et al. Massive haematuria due to an ilio-ureteric fistula. Br J Urol 1986;58: 332. 17. MAHONEY PF, STEPHEN JG. External iliac artery-ureteric fistula. Br J Urol 1987;60(4):374. 18. SMITH RB. Ureteral common iliac artery fistula: a complication of internal double-J ureteral stent. J Urol 1984;132: 113. 19. AKABA N, UJIIE H, UMEZAWA K, et al. A case of sudden gross hematuria caused by an iliac artery-ureteral fistula. Nippon-Geka-Gakkai-Zasshi 1983;84(7):648--653. 20. WATANABE T, KUSABA A, KUMA H, et al. Failure of dacron arterial prostheses caused by structural defects. J
Cardiovasc Surg 1983"24(2):95-100. 21. SZYDOWSKI Z, SKORA K, DAWISKIBA J, et al. Arterioureteral fistula as a late complication following reconstructive surgery on iliac arteries. Pol Przegl Chir 1978;
50(4):329-332. 22. DANG C, SULLIVAN MJ. Traumatic arterio-ureteral fistula: hematuria without urine. J Trauma 1975;15(4):361-362. 23. DI COSTANZO GA, KALMAN PG, TRACHTENBERG J. Erosion of the ureter by iliofemoral arterial prosthesis. J Vasc Surg 1988;8:190-192. 24. TAYLOR WN, REINHART HL. Mycotic aneurysm of
VOLUME 5 No 3 - 1991
25. 26.
27. 28. 29. 30. 31.
32.
33.
ARTERIAL-URETERAL FISTULA
common iliac artery with rupture into right ureter: report of a case. J Urol 1939;42:21-26. DAVIDSON OW, SMITH RP. Uretero-arterial fistula: report of a case. J Urol 1939;42:25%261. HAMER HG. Fatal ureteral hemorrhage due to erosion into the iliac artery: report of a case occurring during indwelling catheter drainage for pyelitis of pregnancy. Trans A m Assoc Genito-Urin Surg 1939;32:177-183. WHITMORE WF. Uretero-arterial fistula and uretero-vaginal fistula: report of a case. Urologia 1954;21:184. COWEN R. Uretero-arterial fistula. J Urol 1955;73:801-803. HODGES CV. Iliac artery-ureteral fistula. Urologist's Correspondence Club Newsletter. July 27, 1959. ARAP S, NARDY OW, GOES GM, et al. Fistula ureteroarterial. Rev Paul Med 1965;67:352. NELSON HN, FRIED FA. Iliac artery-ureteral fistula associated with Gibbons' catheter: a case report and review of the literature. J Urol 1981;125:878-880. JACOBSON ME, MASTIO GJ, BERKAS EM. Ureteral obstruction as a late complication of abdominal aneurysm resection. J Kansas Med Soc 1962;63:516-518. EGEBLAD K, BROCHNER-MORTENSEN J, KRARUP
mum
34. 35. 36. 37. 38. 39.
40.
285
T, et al. Incidence of ureteral obstruction after aortic grafting: a prospective analysis. Surgery 1988;I03:411~,14. SANT GR, HEANEY JA, PARKHURST EC, et al. Obstructive uropathy--a potentially serious complication of reconstructive vascular surgery. J Urol 1983;129:16-22. FRUSHA JD, PORTER JA, BATSON RC. Hydronephrosis following aortofemoral bypass grafts. J Cardiovasc Surg 1982;23:371-377. KAUFMAN JE, PARSONS CL, GOSINK BB, et al. Retrospective study of ureteral obstruction following vascular bypass surgery. Urology 1982;19(3):278-283. SHAW RS, BAUE AE. Management of sepsis complicating arterial reconstructive surgery. Surgery 1963;53:75-86. WRIGHT D J, ERNST CB, EVANS JR, et al. Ureteral complications and aortoiliac reconstruction. J Vasc Surg 1990;1l:29-37. SCHUBERT P, FORTNER G, CUMMINGS D, et al. The significance of hydronephrosis after aortofemoral reconstruction. Arch Surg 1985;120:377-381. M C C A R T H Y WJ, FLINN WR, CARTER MF, et al. Prevention and management of ureteral injuries during aortic surgery. In: BERGAN J, YAO JST (eds). Aortic Surgery. 1st edition. Philadelphia: WB Saunders, 1989.
Arterial-ureteral fistula, a rare cause of gross hematuria, may be associated with life-threatening hemorrhage if not rapidly diagnosed and treated. Recently, a patient at the Hunter H. McGuire Veterans Administration Medical Center developed an arterial-ureteral fistula at the site of the confluence of the external iliac artery and a superior mesenteric artery bypass graft. Review of the world's literature revealed 31 additional reported cases of arterial-ureteral fistulas [1-31]. This current case is only the second one reported in which the diagnosis was made with arteriography. Several common features of arterial-ureteral fistulas were present in this case: a history of ureteral obstruction and urinary tract infections, upper urinary tract disease, and previous vascular surgery. The condition is usually associated with either prior upper urinary tract instrumentation or vascular surgery, and an antecedent period of intermittent hematuria, followed by life-threatening hematuria, is common. A high index of suspicion and early surgical intervention are required for successful management. The major surgical challenges are to establish unobstructed urinary drainage and restore vascular continuity. Exclusion of prosthetic material from potentially infected areas is mandatory. (Ann Vasc Surg 1991;5:282285). KEY WORDS: graft.
Fistula; arterial-ureteral fistula; hematuria; iliac-mesenteric artery
CASE REPORT A 64-year-old man, a T10 paraplegic, presented to the emergency room with a four day history of gross hematuria. His vascular history was significant for repair of an abdominal aortic aneurysm with a dacron tube graft 20 years prior to admission. In 1976, he underwent mesenteric revascularization with a synthetic conduit placed retrograde from his right external iliac artery to the superior mesenteric artery. In addition, his right kidney was revascularized with a saphenous vein conduit from the fight external iliac artery (originat-
From the Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Hunter H. McGuire Veterans Administration Medical Center, Richmond, Virginia. Reprint requests: Michael Sobel, MD, Box 108 MCV Station, Medical College of Virginia, Richmond, Virginia 23298.
ing distal to the mesenteric bypass graft). The original indications for mesenteric and fight renal revascularization are not known. His urologic history was significant for 25 years of paraplegia with bladder management by indwelling catheterization. He had a chronic fight double-J ureteral stent f o r treatment of a ureteral stricture and hydronephrosis. Renal blood flow scans documented decreased right renal blood flow with normal left-sided blood flow. Serum creatinine on admission was 1.6 mg/dl with a blood urea nitrogen of 26 mg/dl. Further evalUation with cystoscopy and retrograde pyelogram revealed blood emanating from the right ureteral stent and proximal right ureteral and pelvic obstruction with multiple filling defects. A right percutaneous nephrostomy was performed, followed by nephroscopy. Upon stent removal, vigorous bleeding was observed precluding adequate visualization of the source through the nephroscope. No hemodynamic instability occurred
282
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283
ARTERIAL-URETERAL FISTULA
retrograde mesenteric graft was well incorporated into the surrounding tissues more cephalad. Direct arterial pressure measurements of the native superior mesenteric artery were normal. To solve the difficult problem of the potentially infected synthetic material, the Dacron graft was dissected free cephalad from the pseudoaneurysm and resected. The portion of the graft anastomosed to the superior mesenteric artery was oversewn and covered with autologous tissue before the pseudoaneurysm was entered. After unroofing the pseudoaneurysm/fistula, an autologous vein patch was used to repair the external iliac artery because it could not be closed primarily. The origin of the iliac artery-renal saphenous vein graft was distal to the fistula and revision of the renal bypass graft unnecessary. Due to the extent of ureteral involvement, the ureter was ligated proximally and distally. A nephrostomy tube was left intact for long-term urinary drainage. Postoperatively, the patient had an uneventful course with no further episodes of bleeding. Intraoperative bacterial cultures were sterile, although pseudomonas species were cultured from his urine. He was maintained on antibiotics for two weeks. His renal function was unchanged postoperatively; serum creatinine was 1.5 mg/dl at discharge. Up to 18 months postoperatively, the patient's right lower extremity blood flow was uncompromised and no problems relating to the repair of the fistula had developed. His renal function had not deteriorated.
DISCUSSION
Fig. 1. Arteriogram reveals saphenous vein-renal artery bypass graft (hollow arrow) along with external lilac artery (large solid arrow). External lilac artery-right ureteral fistula is evident at site of pseudoaneurysm, along with extravasation of contrast into dilated, clot-filled ureter (small solid arrow). Percutaneous nephrostomy tube is visualized laterally.
and the patient was taken to the surgical intensive care unit for observation. Within 24 hours, the nephrostomy tube drainage cleared. On the third day after stent removal the patient had a second episode of massive hematuria with hemodynamic instability. Resuscitation and blood transfusion were begun and an abdominal aortic arteriogram performed. The arteriogram revealed a right external iliac artery pseudoaneurysm at the confluence of the artery with the ureter, with extravasation of contrast into the clot-filled ureter (Fig. 1). The patient was explored transabdominally on an emergency basis. An arterial-ureteral fistula was identified at the anastomosis of the superior mesenteric artery bypass graft to the external iliac artery. This anastomosis was partially dehisced and the pseudoaneurysm was in direct continuity with the infected urinary stream. The Dacron
This review represents a large group of patients gathered from the world's literature with arterialupper urinary tract fistula. Prior to fistula formation, all but three patients had previous vascular surgery or significant upper urinary tract disease requiring stenting of the ureter. In two of the exceptions, penetrating trauma was the cause of fistula formation [10,22], while a congenital arteriovenous malformation of the internal iliac artery and vein was the etiologic factor in the third [12]. Retroperitoneal fibrosis from external beam radiation therapy and subsequent ureteral obstruction played a role in fistula formation in two other patients [4,1 I]. The current patient had a typical history of longstanding ureteral obstruction which developed after reconstructive vascular surgery. Ninety percent of the patients in this review had evidence of ipsilateral ureteral obstruction at the time of fistula formation. In addition, two-thirds of the patients had indwelling ureteral catheters at the time of presentation. First described by J a c o b s o n [32], the potential for ureteral obstruction after aortic surgery is well recognized. Postoperative hydronephrosis has been estimated to occur in 2 to 14% of patients following aortic reconstruction [33-36]. The potentially serious effect of ureteral obstruction on vascular grafts was first recognized by Shaw and Baue in 1963 [37], with subsequent studies reporting a 55 to 89% incidence of graft complications associated with postoperative hydronephrosis [38,39]. These
284
ANNALS OF VASCULARSURGERY
ARTERIAL-URETERAL FISTULA
complications are typically infectious in nature and include anastomotic aneurysm formation, graft infection and thrombosis, and aorto-enteric fistulae [40]. Although arterial-ureteral fistula is a much rarer complication of postoperative ureteral obstruction, gross hematuria in this setting should alert the clinician to the possibility of arterialurinary tract fistula. In 15 of the 22 cases in which the diagnostic evaluation was detailed, the diagnosis of arterialureteral fistula was not made until the time of operation. In two cases the diagnosis was made at autopsy [13,20]. The current patient is the second case reported in which the diagnosis was made preoperatively with an arteriogram [31]. Three patients were diagnosed by retrograde ureterogram [4,7,19]. Cystoscopy was only helpful in lateralizing the bleeding to the involved ureter. Ureteroscopy and nephroscopy may be helpful in further localizing the site of hemorrhage. Seventy-three percent (16/22) of the patients in whom the clinical history was detailed were hypotensive upon presentation, demonstrating the severity of the hematuria. Seventy-seven percent (17/ 22) required blood transfusion. Twenty-one of 27 patients were treated surgically; three deaths in the perioperative period were reported for a surgical mortality of 14%. Six patients had nonoperative therapy with a mortality of 83%. The surviving patient treated nonsurgically had arteriographic embolization of the right common iliac artery after the diagnosis was made by retrograde ureterogram [4]. Goals in the surgical management of arterialureteral fistula include; (1) control of hemorrhage and restoration of vascular continuity; (2) provision of adequate urinary drainage; and (3) removal and exclusion of potentially infected prosthetic material. Renal salvage should also be attempted; this was possible in 67% of patients in this review. Management of the involved ureter is dependent on the location and extent of ureteral involvement and may include ureterectomy, excision and bladder reimplantation, ureterostomy, uretero-ureterostomy, and excision and primary repair over a double-J stent [7,11,12,16,31]. Vascular control of the arterial-ureteral fistula required ligation of the internal or common iliac artery in 48% of patients (10/21). All of these patients required revascularization after ligation. In patients with prosthetic arterial bypass grafts, the potentially infected fistula creates another obstacle in management. Protection and exclusion of uninfected and uninvolved segments of the bypass graft is important, as is specific postoperative antibiotic therapy. The optimal duration of antibiotic therapy is not known and should be dictated by the presence or absence of prosthetic material and gross contamination. Restoration of vascular integrity may be obtained with the use of autologous tissue f o r
vascular repair of the fistula or excision of potentially infected prosthetic material and extraanatomic bypass.
REFERENCES 1. AHLBORN TH, BIRKHOFF JD, NOWYGROD R. Common iliac artery-ureteral fistula: case report and literature review. J Vasc Surg 1986;3:155-158. 2. NICITA G, LUNGHI F, DILIGENTI LM, et al. Arteriovesical fistula after ureterolithotomy: a case report and review of the literature. J Urol 1978 ;120:370-371. 3. SHULTZ ML, EWING DD, LOVETT VF. Fistula between lilac aneurysm and distal stump of ureter with hematuria: a case report. J Urol 1974;112:585-586. 4. TOOLIN E, POLLACK HM, MC LEAN GK, et al. Ureteroarterial fistula: a case report. J Urol 1984;132:553-554. 5. RENNICK JM, LINK DP, PALMER JM. Spontaneous rupture of an iliac artery aneurysm into a ureter: a case report and review of the literature. J Urol 1976;116:111-113. 6. KAR A, ANGWAFO FF, JHUNJHUNWALA JS. Ureteroarterial and ureterosigmoid fistula associated with polyethylene indwelling ureteral stents. J Urol 1984;132:755-757. 7. WHEATLEY JK, ANSLEY JD, SMITH RB, et al. Ureteroarterial fistula. Urology 1981;18:498-502. 8. ADAMS PS, Jr. Iliac artery ureteral fistula developing after dilatation and stent placement. Radiology 1984;153:647-648. 9. BAUM ML, BAUM RD, PLAINE L, et al. Computed tomography in the diagnosis of fistula between the ureter and iliac artery. J Comput Assist Tomogr 1987;11(4):719-721. 10. ROUS SN, ANDRONACO JT. Post-traumatic aneurysm of the iliac artery with rupture directly into bladder: a case report and review of the literature. J Urol 1972;108:722-723. 11. REINER RJ, CONWAY GF, THRELKELD R. Ureteroarterial fistula. J Urol 1975;113:24-25. 12. SHARMA SK, GOSWAMI AK, SHARMA GP, et al. Congenital iliac arteriovenous malformation: a cause of massive hematuria and ureteral obstruction. J Urol 1988;139:355356. 13. SHETTY SD, READ JR, NEWLING DWW. Ureteroarterial fistula. Br J Urol 1988;62(4):382-383. 14. GOLDBERG PL, HENDRY WF, WHITFIELD HN, et al. A case of uretero-arterial fistula. Br J Urol 1981;54:196. 15. JOOST J, BARTSCH G, WEIMANN S, et al. Ilioureteric fistula. Br J Urol 1981;53:477. 16. BEARD JD, SOMERVILLE PG, WARD JP, et al. Massive haematuria due to an ilio-ureteric fistula. Br J Urol 1986;58: 332. 17. MAHONEY PF, STEPHEN JG. External iliac artery-ureteric fistula. Br J Urol 1987;60(4):374. 18. SMITH RB. Ureteral common iliac artery fistula: a complication of internal double-J ureteral stent. J Urol 1984;132: 113. 19. AKABA N, UJIIE H, UMEZAWA K, et al. A case of sudden gross hematuria caused by an iliac artery-ureteral fistula. Nippon-Geka-Gakkai-Zasshi 1983;84(7):648--653. 20. WATANABE T, KUSABA A, KUMA H, et al. Failure of dacron arterial prostheses caused by structural defects. J
Cardiovasc Surg 1983"24(2):95-100. 21. SZYDOWSKI Z, SKORA K, DAWISKIBA J, et al. Arterioureteral fistula as a late complication following reconstructive surgery on iliac arteries. Pol Przegl Chir 1978;
50(4):329-332. 22. DANG C, SULLIVAN MJ. Traumatic arterio-ureteral fistula: hematuria without urine. J Trauma 1975;15(4):361-362. 23. DI COSTANZO GA, KALMAN PG, TRACHTENBERG J. Erosion of the ureter by iliofemoral arterial prosthesis. J Vasc Surg 1988;8:190-192. 24. TAYLOR WN, REINHART HL. Mycotic aneurysm of
VOLUME 5 No 3 - 1991
25. 26.
27. 28. 29. 30. 31.
32.
33.
ARTERIAL-URETERAL FISTULA
common iliac artery with rupture into right ureter: report of a case. J Urol 1939;42:21-26. DAVIDSON OW, SMITH RP. Uretero-arterial fistula: report of a case. J Urol 1939;42:25%261. HAMER HG. Fatal ureteral hemorrhage due to erosion into the iliac artery: report of a case occurring during indwelling catheter drainage for pyelitis of pregnancy. Trans A m Assoc Genito-Urin Surg 1939;32:177-183. WHITMORE WF. Uretero-arterial fistula and uretero-vaginal fistula: report of a case. Urologia 1954;21:184. COWEN R. Uretero-arterial fistula. J Urol 1955;73:801-803. HODGES CV. Iliac artery-ureteral fistula. Urologist's Correspondence Club Newsletter. July 27, 1959. ARAP S, NARDY OW, GOES GM, et al. Fistula ureteroarterial. Rev Paul Med 1965;67:352. NELSON HN, FRIED FA. Iliac artery-ureteral fistula associated with Gibbons' catheter: a case report and review of the literature. J Urol 1981;125:878-880. JACOBSON ME, MASTIO GJ, BERKAS EM. Ureteral obstruction as a late complication of abdominal aneurysm resection. J Kansas Med Soc 1962;63:516-518. EGEBLAD K, BROCHNER-MORTENSEN J, KRARUP
mum
34. 35. 36. 37. 38. 39.
40.
285
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