Uretero-arterial fistulas: update and therapeutic advances - Literature review based on two clinical cases

Michel Bailly, Vincent Scavée, Christian Van Ruyssevelt, Olivier Rahier, Jean-Luc Jorion, Emmanuel Dardenne Published in the journal : May 2021 Category : Urology

Summary :

Uretero-arterial fistulas (UAFs) are the consequence of a chronic inflammatory process that leads to the weakening of ureteral and arterial walls at the crossing level. In recent years, the number of cases described in the literature has continuously increased. Most UAFs are accounted for by the exposure to several typical risk factors. Clinical suspicion is the key for a rapid diagnosis and appropriate treatment. Management of UAFs has evolved over time, being currently based on an endovascular approach. Despite an improvement in diagnostic and therapeutic techniques, morbidity and mortality remain high.

This work, which is based on two clinical cases with different presentation and management, illustrates the heterogeneity of this pathology, which is often barely understood. In addition, the article proposes a review of the current recommendations on the subject.

What is already known about the topic?

Uretero-arterial fistulas are rare but potentially life-threatening. Most fistulas are secondary to a set of typical risk factors. Treatment is primarily based on endovascular surgery.

What does this article bring up for us?

This article reflects the increase in the number of reported cases, illustrates the heterogeneity of the clinical presentation, and underlines the relevance of suspecting clinically a fistula when faced with typical risk factors. It provides a summary of the literature on the subject, including some recent advances that were mainly made in therapeutic management.

Key Words

Uretero-arterial fistula, hematuria, endovascular surgery