Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment. This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management. We identified 17 UAF in 16 patients (12 male, 4 female, mean age 69.8 ± 11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1–3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases (82.4%). Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%). Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary. Level 4, case series.

中文翻译：

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输尿管动脉瘘的管理和血管内治疗：来自一个中心的经验和文献复习

输尿管动脉瘘（UAF）是一种罕见但可能危及生命的疾病。这项研究的目的是评估UAF治疗的血管内治疗的结果。该回顾性病例系列评估了UAF的经皮支架移植（SG）血管成形术和/或线圈栓塞的单一中心经验。患者随访包括技术和早期临床成功，并发症和修订程序。我们还对有关血管内UAF管理的文献报道进行了系统的综述。我们在三级医院接受血管内UAF治疗的16例患者（男性12例，女性4例，平均年龄69.8±11.3岁）中鉴定出17例UAF。所有患者均出现血尿。5/17（29.4％）的患者出现了胁腹痛，其中7例（41.2％）的患者出现了低血容量性休克。UAF的危险因素包括所有瘘管中都留有慢性输尿管支架，大骨盆手术13例（76.5％）。在6例（35.3％）的患者中，在近端proximal内动脉（IIA）线圈栓塞后，从总动脉（CIA）到the外动脉（EIA）放置了SG。在没有瘘管栓塞的情况下，将SG放置在10例瘘管中（58.8％）。在一种情况下，仅对IIA进行线圈栓塞。平均随访时间为654天（范围：1-3269）。所有手术均在技术上成功，并且在随访期间未发生与手术相关的死亡。初次住院期间，血尿消失的病例为14/17例（82.4％）。总体而言，有4例患者出现了复发性血尿，其中3例在二次干预后得以缓解。在初始治疗后229天的随访期间，发生了1例与UAF相关的复发性死亡。从我们的系统文献回顾中，总共对152例UAF病例进行了分析：140例（92.1％）进行了有无栓塞的SG置入，12例（7.9％）单独进行了栓塞。并发症包括UAF复发（18 / 152，11.8％），SG血栓形成（7 / 140，5％）和SG感染（5 / 140，3.6％），总并发症率为13.8％。五名患者因UAF死亡（3.3％）。血管内疗法可提供很高的技术成功率，并能快速控制UAF的出血。严重的并发症（如SG阻塞或SG感染）很少见，但意义重大。抗生素治疗和单一抗血小板治疗可改善SG的耐用性，并进行密切和长期的随访，以便在必要时及时进行重复的血管内或外科治疗。级别4，案例系列。