INTRODUCTION Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter. CASE PRESENTATION We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up. CONCLUSION The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery remains the best treatment option, although there is increasing evidence of successful endovascular treatment.

中文翻译：

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解剖外髂股旁路手术中自体大隐静脉移植物和膀胱瘘引起的大量血尿：病例报告。


引言 尿路动脉破裂引起的肉眼血尿是一种罕见但可能致命的疾病。据报道，髂动脉瘤、盆腔放射手术、血管重建手术、肾盂输尿管连接部狭窄手术以及移植与这种情况有关。在血管重建手术组中，最常见的病因是退化动脉或输尿管合成移植物的破裂。病例介绍 我们介绍一例膀胱右髂股自体静脉解剖外移植物近端吻合处小吻合假性动脉瘤破裂的病例。据我们所知，这是首例膀胱自体静脉移植物破裂的报告。我们的患者是一名 24 岁的阿尔巴尼亚农民，因失血性血尿导致严重失血性休克被送往急诊科。他立即接受了手术，直接缝合膀胱，并用合成材料替换了隐静脉移植物。患者完全康复，无血尿，术后膀胱镜检查和计算机断层扫描血管造影在 2 年随访中未显示泌尿道和动脉之间存在病理连通的迹象。结论 由于泌尿外科和血管手术、盆腔肿瘤手术和放射治疗的使用不断增加，动脉尿路瘘的发病率不断增加。除了涉及退化动脉和输尿管或合成移植物和输尿管的瘘管外，它们还可能涉及自体静脉移植物和膀胱。 在我们的患者中，瘘管是由于解剖外位置的自体静脉髂股旁路近端吻合处的假性动脉瘤侵蚀膀胱造成的。尽管越来越多的证据表明血管内治疗是成功的，但开放手术仍然是最好的治疗选择。