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Zentralbl Chir 2003; 128(9): 768-773
DOI: 10.1055/s-2003-42757
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© Georg Thieme Verlag Stuttgart · New York

Die iliakoureterale Fistel und ihre Therapie

Iliac artery-ureteral fistula and its treatmentJ. Krenzien1 , R. Wagner1
  • 1Abteilung für Gefäß- und Thoraxchirurgie, Klinikum Ernst von Bergmann Potsdam
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Publication History

Publication Date:
07 October 2003 (online)

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Zusammenfassung

Die iliakoureterale Fistel ist eine seltene Entität, die sich mit einer massiven, mitunter lebensbedrohenden Blutung manifestieren kann. Über die Hälfte der bisher bekannten Fälle wurden in den letzten 10 Jahren beobachtet. Ihre Ursachen finden sich häufig nach urologisch-gynäkologischen Malignomoperationen mit und ohne Radiatio, nach Einlage von ureteralen Stents und bei gefäßchirurgischen Erkrankungen bzw. nach rekonstruktiven Gefäßoperationen. Die Diagnostik - die Angiographie ist die Methode der Wahl - ist aufgrund der intermittierenden Symptomatik schwierig, Therapie und Prognose für das Leben und den Funktionserhalt der Niere hängen hiervon ab. Die offene chirurgische Versorgung ist weitgehend verlassen worden. Mit Einführung der interventionellen Methoden auf dem Hintergrund eines bildgebenden Fistelnachweises wurden die Morbidität und Letalität deutlich gesenkt. In unserer Abteilung wurden in den letzten 5 Jahren insgesamt drei Patienten mit einer iliakoureteralen Fistel behandelt. Bei zwei von ihnen kamen gecoverte Stents, einmal die alleinige Intervention, das Coiling der A. iliaca interna, erfolgreich zur Anwendung. Eine Versorgung des Ureters ist nicht zwingend erforderlich.

Abstract

Arterio-ureteral fistulas are rare. A lifethreatening complication is severe hemorrhage. More than 50 per cent of the cases were reported during the last ten years. The predisposing causes mainly are operations of malignomas of the kidney and the efferent urinary tract as well as gynecological neoplasias with or without irradiation. Stenting of the ureter or reconstructive vascular surgery may also cause arterio-ureteral fistulas. Because of the intermittent symptomatology diagnosis may be very difficult. Therapy and prognosis for life as well as for organ failure depend on pretherapeutic examination. In former times surgical repair was the therapy of choice. With the indroduction of interventional techniques morbidity and mortality decreased significantly. During the last five years three patients with iliac-ureteral fistulas were treated in our department. In two cases the fistulas was excluded by covered stent grafts, in one case coiling alone of the internal iliac artery was successful. Reviewing the literature and our experience with arterio-ureteral fistula angiography is recommended for diagnostics. Covered iliac stentgrafts are the therapeutic option of choice. The leakage of the ureter needs not to be repaired mandatoryly.

Schlüsselwörter

Arterioureterale Fistel - Stent-Graft - Hämaturie - Übersicht

Key words

Arterio-ureteral fistula - hematuria - stent graft - review

Literatur

  • 1 Abal V C, Veiga F G, Escandon A S, Martin M G. Common iliac artery-ureteral fistula: a case report and literature review.  Arch Esp de Urol. 1993;  46 843-846
    PubMedGoogle Scholar
  • 2 Adams P S. Iliac artery-ureteral fistula developing after dilatation and stent placement.  Radiology. 1984;  153 647-648
    PubMedGoogle Scholar
  • 3 Ahlborn T N, Birkhoff J D, Nowygrod R. Common iliac artery-ureteral fistula: case report and literature review.  J Vasc Surg. 1986;  3 155-158
    PubMedGoogle Scholar
  • 4 Arap S, Nardy O W, Goes G M, Azevedo J R, de Campus F JG. Fistula ureteroarterial.  Rev Paul Med. 1965;  67 352-356
    PubMedGoogle Scholar
  • 5 Asham E H, Walsh M, Adiseshiah M. An unusual case of haematuria trated by endoluminal repair.  Eur J Endovasc Surg. 1999;  17 89-90
    PubMedGoogle Scholar
  • 6 Batter S, McGovern F, Cambria R P. Ureteroaterial fistula: a case report and a review of the literature.  Urol. 1996;  48 481-489
    CrossrefPubMedGoogle Scholar
  • 7 Bettman M A, Murray P D, Perlmutt L M, Whitmore W F, Richie J P. Uretero-ileal anastomotic leaks: percutaneous treatment.  Radiology. 1983;  148 95-100
    PubMedGoogle Scholar
  • 8 Bergqvist D, Pärsson H, Sherif A. Arterio-ureteral fistula-a systematic review.  Eur J Endovasc Surg. 2001;  22 191-196
    PubMedGoogle Scholar
  • 9 Bodalk A, Levot E, Schut A, Vincent J P, Lagneau P. Un case de fistule arterioureterale.  J Urol. 1990;  96 55-59
    PubMedGoogle Scholar
  • 10 Brown K R, Jean-Claude J M, Rilling W S, Donnell R F, Seabrook G R, Towne J B, Cambria R A. Arterioureteral fistula. Report of two cases and a review of the literature.  Vasc Surg. 2000;  34 437-445
    PubMedGoogle Scholar
  • 11 Bullock A, Andriole G L, Neumann N, Sicard G. Renal autotransplantation in the management of a ureteroarterial fistula: a case report and review of the literature.  J Vasc Surg. 1992;  15 436-441
    PubMedGoogle Scholar
  • 12 Dalmas P, Haddad O, Jacquier A, Lechevallier E, Andrè M, Bartoli J M, Coulange C. Arterio-ureteric fistula: diagnostic and therapeutic approach.  Prog Urol. 2001;  11 1277-1281
    PubMedGoogle Scholar
  • 13 Dauvergne P, Devic J, Tourniaire J, Berteau F. Fistule uretero-arterielle iliaque: traitement endovasculaire. Complication du maintien prolonge d'une endoprothese double.  J Prog Urol. 2001;  11 534-537
    PubMedGoogle Scholar
  • 14 Davidson O W, Smith R P. Uretero-arterial fistula: report of a case.  J Urol. 1939;  42 21-26
    PubMedGoogle Scholar
  • 15 De Pascale S E, Mylonas I, Falkenberry S S. Fatal recurrent uretroarterial fistulas after exenteration for cervical cancer.  Gynecol Oncol. 2001;  82 192-196
    CrossrefPubMedGoogle Scholar
  • 16 Faraglia V, Michetti P M, Travaglia S, Barrese F, Cristini C, Morello P, Fischetti G. Uretero-arterial fistula as a comolication of vascular surgery.  Minerva Urol Nefrol. 1999;  51 159-161
    PubMedGoogle Scholar
  • 17 Feuer D S, Ciocca R G, Nackman G B, Siegel R L, Graham A M. Endovascular management of ureteroarterial fistula.  J Vasc Surg. 1999;  30 1146-1149
    PubMedGoogle Scholar
  • 18 Finney R P. Experience with new double J ureteral catheter stent.  J Urology. 1978;  120 678-681
    PubMedGoogle Scholar
  • 19 Gheiler E L, Tefilli M V, Tiguert R, Friedland M S, Frontera R C, Pontes J E. Angiographic arterial occlusion and extra-anatomical vascular bypass for the management of a ureteral-iliac fistula: case report and review of the literature.  Urol Int. 1998;  61 62-66
    PubMedGoogle Scholar
  • 20 Gibbons M, O'Donnel S, Lukens M, Meglin A, Costabile R A. Treatment of a intraluminal endovascular graft.  J Urol. 1998;  159 2083-2084
    PubMedGoogle Scholar
  • 21 Grime P D, Wilmshurst C C, Clyne C AC. Spontaneous iliac artery aneurysm-ureteric fistula.  Eur J Vasc Surg. 1989;  3 455-456
    PubMedGoogle Scholar
  • 22 Goldberg P L, Hendry W F, Whitfield H N, Wickham J EA. A case of uretero-arterial fistula.  Br J Urol. 1982;  54 196
    PubMedGoogle Scholar
  • 23 Hamer H G. Fatal ureteral hemorrhage due to erosion into the iliac artery: report of a case occuring during indwelling catheter drainage for pyelonephritis of pregnancy.  Genito-Urin Surg. 1939;  32 177-183
    PubMedGoogle Scholar
  • 24 Han K R, Pantuck A J, Siegel R L, Bodnar L J, Ciocca R G, Nosher J L, Weiss R E, Cummings K B, Perrotti M. Endovascular stent graft for management of ureteroarterial fistula after orthotopic bladder substitution.  Tech Urol. 1999;  5 169-173
    PubMedGoogle Scholar
  • 25 Hausegger von K A, Sonnleitner J, Uggowitzer M, Klein G E, Petrisch P. Iliako-ureterale Fistel, eine seltene Komplikation bei Ureterschienung.  Fortschr Röntgenstr. 1996;  164 525-526
    PubMedGoogle Scholar
  • 26 Herranz A F, Camunez F, Diez C JM, Verdu T F, Liedo G E, Bueno C G. Fistula uretero-iliaca.  Arch Esp Urol. 1998;  51 818-820
    PubMedGoogle Scholar
  • 27 Kato N, Kawaguchi T, Kondo T, Hasegawa Y, Ishida M, Sakuma H, Kawamura J, Yada I, Takeda K. Re: Ureterooarterial fistula: endovascular repair with a stent-graft.  Cardiovasc Intervent Radiol. 2002;  25 158-159
    CrossrefPubMedGoogle Scholar
  • 28 Kawabata G, Yamanaka N, Shimogaki H, Umezu K, Wakita N. Uretero-external iliac artery fistula: a case report.  Hinyokika Kiyo. 1998;  44 829-832
    PubMedGoogle Scholar
  • 29 Keller F S, Barton R E, Routh W D, Gross G M. Gross hematuria in two patients with ureteral-ileal conduits and double-J stents.  J Vasc Intervent Radiology. 1990;  1 69-79
    PubMedGoogle Scholar
  • 30 Kern DB, Darcy M D, Baumann D S, Allen B T. Autologous vein-covered stent for the endovascular management of an iliac artery-ureteral fistula: case report and review of the literature.  J Vasc Surg. 1996;  24 680-688
    PubMedGoogle Scholar
  • 31 Krenzien J, Zimmermann H B, Schott H. Die iliakoureterale Fistel und ihre Behandlung mit einem Stent-Graft.  Chirurg. 1998;  69 977-980
    CrossrefPubMedGoogle Scholar
  • 32 Levi N, Sonksen J R, Iversen P, Helgstrand U. Rupture of an iliac artery pseudo-aneurysm into a ureter.  Eur J Endovasc Surg. 1999;  17 264-265
    PubMedGoogle Scholar
  • 33 List N, Collins J, McCormick M. Massive hemorrhage from an arterioureteral fistula associated with chronic renal transplant failure.  J Urol. 1990;  144 1229-1230
    PubMedGoogle Scholar
  • 34 Lytton B. Ureteral obstruction following aortofemoral bypass.  Surgery. 1966;  59 918-922
    PubMedGoogle Scholar
  • 35 Madoff D C, Toombs B D, Skolkin M D, Bodurka D C, Modesitt S C, Wood C G, Hicks M E. Endovascular management of ureteral-iliac artery fistulae with wallgraft endoprotheses.  Gynecol Oncol. 2002;  85 212-217
    CrossrefPubMedGoogle Scholar
  • 36 Marco P LM, Vigues J F, Trilla H E, Dominguez E J, Ponce C A, Gonzales S C, Aguilo L F, Serrallach M N. Hematuria secondary to arterio-ureteral fistula. Endovascular treatment.  Acta Urol Esp. 2001;  25 668-671
    PubMedGoogle Scholar
  • 37 Martinez V MB, Gomez A EM. Postappendectomy arterio-ureteral fistula.  Actas Urol Esp. 1980;  4 331-334
    PubMedGoogle Scholar
  • 38 Moschcowitz A V. Simultanous ligation of both external iliac arteries for secondary hemorrhage following bilateral ureterolithotomy.  Ann Surg. 1908;  48 872-875
    PubMedGoogle Scholar
  • 39 Nakajiama F, Demura A, Katsuoka Y. A fistula between the common iliac artery and ureter following cutaneous ureterostomy: a case report.  Hinyokika Kiyo. 1999;  45 539-541
    PubMedGoogle Scholar
  • 40 Nelson H N, Fried F A. Iliac artery-ureteral fistula associated with Gibbons' catheter: a case report and review of the literature.  J Urology. 1981;  125 878-880
    PubMedGoogle Scholar
  • 41 Nicita G, Lunghi F, Diligenti L M, Ferrarese D, Fiorelli C, Turini D. Arteriovesical fistula after ureterolithotomy: a case report and review of the literure.  J Urol. 1978;  120 370-371
    PubMedGoogle Scholar
  • 42 Qillin S P, Darcy M D, Picus D. Angiographic evaluation and therapy of ureteroarterial fistulas.  AJR. 1994;  162 873-878
    PubMedGoogle Scholar
  • 43 Reiner R J, Conway G F, Threlkeld R. Ureteroarterial fistula.  J Urol. 1975;  116 24-25
    PubMedGoogle Scholar
  • 44 Rennick J M, Link D P, Palmer J M. Spontaneous rupture of an iliac artery aneurysm into a ureter: a case report and review of the literature.  J Urology. 1976;  116 111-113
    PubMedGoogle Scholar
  • 45 Sant G R, Heany J A, Parkhurst E C. Obstructive uropathy - a potentially serious complication of reconstructive vascular surgery.  J Urol. 1983;  129 582-583
    PubMedGoogle Scholar
  • 46 Schapira H E, Ronald L I, Gribetz M, Wulfsohn M A, Brendler H. Ureteral injuries during vascular surgery.  J Urol. 1981;  125 293-297
    PubMedGoogle Scholar
  • 47 Schultz M L, Ewing D D, Lovett V F. Fistula between iliac aneurysm and distal stump of ureter with hamaturia: a case report.  J Urol. 1975;  116 111-113
    PubMedGoogle Scholar
  • 48 Sharma S K, Goswani A K, Sharma G P, Malakondiah G C, Khanna S K. Congenital iliac arteriovenous malformation: a cause of massive hematuria and ureteral obstruction.  J Urol. 1988;  139 264-265
    PubMedGoogle Scholar
  • 49 Sherif A, Karacagil S, Magnusson A, Nym,an R, Norlen B J, Bergqvist D. Endovascular approach to treating secondary arterioureteral fistula.  Scand J Urol Nephrol. 2002;  36 80-82
    PubMedGoogle Scholar
  • 50 Shucksmith H S. Duodenal, sigmoid, and ureteric fistulas resulting from aortic-iliac grafts or endarterectomy.  Brit J Surg. 1968;  55 402-403
    PubMedGoogle Scholar
  • 51 Sparwasser C, Kugler A, Gilbert P, Bähren W, Hartel W, Pust R. Bilaterale ureteroiliakale Fisteln in Zusammenhang mit Radiatio und ureteraler Splintung.  Urologe. 1994;  33 85-87
    PubMedGoogle Scholar
  • 52 Taylor W N, Reinhart H L. Mycotic aneurysm of common iliac artery with rupture into right ureter: report of a case.  J Urol. 1939;  116 24-26
    PubMedGoogle Scholar
  • 53 Thirty A J, Struyven J, DeCasseye van M. Spontaneous rupture of right iliac arterial aneurysm into ureter.  Urology. 1980;  16 101-103
    CrossrefPubMedGoogle Scholar
  • 54 Toolin E, Pollack H M, McLean G K, Banner M P, Wein A J. Uretero-arterial fistula: a case report.  J Urol. 1984;  132 553-554
    PubMedGoogle Scholar
  • 55 Tresidder G C, Blandy J P, Singh M. Omental sleeve to prevent retroperitoneal fibrosis under the ureter.  Urol Int. 1972;  27 144-148
    PubMedGoogle Scholar
  • 56 Van Damme H, Keppenne V, Sakalihasen N, Andrianne R, Limet R. Uretro-arterial fistula: two observations.  Acta Chir Belg. 1997;  97 133-136
    PubMedGoogle Scholar
  • 57 Vandersteen D R, Saxon R R, Fuchs E, Keller F S, Taylor L M, Barry J M. Diagnosis and management of ureteroiliac artery fistula: value of provocative arteriography followed by common iliac artery embolization and extraanatomic arterial bypass grafting.  J Urology. 1997;  158 748-758
    PubMedGoogle Scholar
  • 58 Wheatley J, Ansley J, Smith R, Trulock T S, Campbell D. Ureteroarterial fistula.  Urol. 1981;  18 498-502
    CrossrefPubMedGoogle Scholar
  • 59 Zweers H MM, Driel van M F, Mensink H JM. Iliac artery-ureteral fistula associated with an indwelling ureteral stent.  Urol Int. 1991;  46 213-214
    PubMedGoogle Scholar

Dr. J. Krenzien

Abteilung für Gefäß- und Thoraxchirurgie · Klinikum Ernst von Bergmann

Charlottenstraße 72

14462 Potsdam

Email: j.krenzien@t-online.de