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Home > Vascular Annual Meeting > PVSS23. The Impact of Endovascular Treatment for...

PVSS23. The Impact of Endovascular Treatment for Uretero-Iliac Artery Fistula: A Single-Center Experience

Rafael D. Malgor, MD; Gustavo S. Oderich, MD; James C. Andrews, MD; Joseph J. Ricotta, MD; J. Chad Fleming, MD; Thomas C. Bower, MD; Haraldur Bjarnason, MD; Audra A. Duncan, MD; Manju Kalra, MBBS; Peter Gloviczki, MD
Mayo Clinic; Rochester, MN

OBJECTIVES: Review the results of open surgical and endovascular treatment for ureteral-iliac artery fistula (UIAF).

METHODS: Data of all patients with UIAF were reviewed from 1996 to 2008. Endpoints were early morbidity and mortality, survival, patency, arterial infection and freedom from recurrent bleeding.

RESULTS: There were 18 patients, 5 male and 13 female, with mean age of 67 years. Predisposing factors were prior tumor resection in 15 patients, radiation (14), ureteral stents (13), ileal conduits (4), and aortofemoral grafts (2). All patients presented with hematuria which was massive in 7. Eleven patients (61%) underwent iliac artery stent grafting (IASG) including four internal iliac artery exclusion. Three patients underwent direct iliac artery repair, 3 had femoral crossover bypass with iliac embolization, and 1 had ureteral exclusion. There were no early deaths. Early complications were 2 enterocutaneous fistulas following direct iliac artery repair, a TIA, hemothorax, femoral access thrombosis in 1 patient each . One possible infection occurred after IASG in a patient with enteric contamination. Mean follow-up was 26 months. At 5-years, overall survival was 45% versus 90% expected for the general population (p<.001). Freedom from recurrent bleeding at 3-years was 76%. Primary and secondary IASG patency at 3-years was 82% and 100%.

CONCLUSIONS: Iliac artery stent grafts are a safe, effective, and durable option in patients with UIAF. Stent graft infections are uncommon, but patients with enteric fistulas should be considered for extra-anatomic reconstruction with iliac embolization. Direct open iliac artery repair carries a high risk of enterocutaneous fistula.

AUTHOR DISCLOSURES: R.D. Malgor, None; G.S. Oderich, None; J.C. Andrews, None; J.J. Ricotta, None; C. Fleming, None; T.C. Bower, None; H. Bjarnason, None; A.A. Duncan, None; M. Kalra, None; P. Gloviczki, None.