Skip to main content

Vascular-Urinary (Ureteroarterial) Fistula — Management

A rare but life-threatening condition, most commonly involving the common iliac artery (48%), with risk factors including prior pelvic surgery (87%), long-term ureteral stents (72%), pelvic radiation (46%), and malignancy (68%).[1] See clinical page: Vascular-Urinary Fistula.

Endovascular Stent-Graft Placement​

The preferred initial treatment in most cases due to lower invasiveness, particularly in hemodynamically unstable or comorbid patients. Allows simultaneous diagnosis and treatment via angiography.[1][2][3]

Open Surgical Repair​

Arterial bypass, ligation, or graft interposition — indicated for preexisting vascular reconstruction, manifest infection, abscess formation, or failed endovascular therapy.[4][5]

Provocative Arteriography​

Angiography with concurrent ureteral manipulation is diagnostically superior when standard CT and angiography are non-diagnostic.[6]

Outcomes​

Overall mortality is approximately 47% (largely driven by underlying malignancy), with a 10–20% fistula-related mortality rate. Recurrent bleeding and lower-extremity complications are common; long-term anticoagulation is generally recommended.[2]

References​

1. Ebata Y, Morisaki K, Matsubara Y, et al. A systematic review of management of ureteroarterial fistula. J Vasc Surg. 2022;76(5):1417–1423.e5. doi:10.1016/j.jvs.2022.05.015

2. Fox JA, Krambeck A, McPhail EF, Lightner D. Ureteroarterial fistula treatment with open surgery versus endovascular management: long-term outcomes. J Urol. 2011;185(3):945–50. doi:10.1016/j.juro.2010.10.062

3. Pillai AK, Anderson ME, Reddick MA, Sutphin PD, Kalva SP. Ureteroarterial fistula: diagnosis and management. AJR Am J Roentgenol. 2015;204(5):W592–8. doi:10.2214/AJR.14.13405

4. Sachsamanis G, Pfister K, Kasprzak PM, et al. Midterm results after open surgical and endovascular management of arterioureteral fistula. Ann Vasc Surg. 2021;73:280–289. doi:10.1016/j.avsg.2020.11.014

5. Badia D, Hillard B, Ritchie C, et al. Ureteral arterial fistula — a role for open operation in the 21st century. Ann Vasc Surg. 2021;74:518.e1–518.e5. doi:10.1016/j.avsg.2020.10.032

6. Vandersteen DR, Saxon RR, Fuchs E, et al. Diagnosis and management of ureteroiliac artery fistula: value of provocative arteriography followed by common iliac artery embolization and extra-anatomic arterial bypass grafting. J Urol. 1997;158(3 Pt 1):754–8.