Chen JJ, Wang J, Zheng QG, Sun ZH, Li JC, Xu ZL, Huang XJ. Uretero-lumbar artery fistula: A case report. World J Clin Cases 2021; 9(32): 10013-10017 [PMID: 34877344 DOI: 10.12998/wjcc.v9.i32.10013]
Corresponding Author of This Article
Xiao-Jun Huang, Doctor, Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, Zhejiang Province, China. hxj258111@163.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jia-Jian Chen, Jian Wang, Qi-Gang Zheng, Zhao-Hui Sun, Jia-Cheng Li, Zi-Lei Xu, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Xiao-Jun Huang, Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
Author contributions: Chen JJ and Huang XJ conceived and wrote the report; Chen JJ and Wang J performed the operation; Zheng QG, Sun ZH, Li JC, and Xu ZL organized the data; Huang XJ revised the paper; All authors have read and approved the final manuscript.
Supported byNational Natural Science Foundation of China (General Program), No. 81874400.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Jun Huang, Doctor, Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, Zhejiang Province, China. hxj258111@163.com
Received: July 2, 2021 Peer-review started: July 2, 2021 First decision: July 15, 2021 Revised: July 29, 2021 Accepted: September 10, 2021 Article in press: September 10, 2021 Published online: November 16, 2021
Abstract
BACKGROUND
Uretero-arterial fistula (UAF) is a disease that usually involves the aorta, common iliac artery, external iliac artery, hypogastric artery, and lumbar artery. Among them, uretero-lumbar artery fistula (ULAF) is the most unusual type. So, both in China and around the world, the diagnosis and treatment of ULAF is a big challenge.
CASE SUMMARY
A 55-year-old female patient with a history of pelvic radiotherapy developed unexplained massive hemorrhage during replacement of the right Resonance metallic ureteral double-J tubes due to a long-standing indwelling ureteral stent for ureteral stricture. Later, we found contrast extravasation from the patient's right L4 artery into the ureter under digital subtraction angiography (DSA) and administered polyvinyl alcohol particle embolic agent and coil embolization; hematuria was controlled. Follow-up investigations at 18 mo showed no sign of recurrence.
CONCLUSION
DSA is very important in the diagnosis and treatment of UAF, and DSA should be preferred when UAF is suspected. In addition, the use of softer ureteral stents in patients with primary disease and risk factors for UAF should be considered to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.
Core Tip: Uretero-arterial fistula (UAF) has an unclear etiology due to the small number of cases. Uretero-lumbar artery fistula is the least common type of UAF. We report the case of a patient with uretero-lumbar artery fistula in whom we embolized the patient's right L4 artery under digital subtraction angiography, and hematuria was controlled. This case highlights the importance of digital subtraction angiography in the diagnosis and treatment of UAF. We recommend the use of softer ureteral stents in patients with primary disease and risk factors for UAF to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.