Endoleak and Pseudoaneurysm Formation in the Setting of Stent Graft Infection Following Endovascular Uretero-Arterial Fistula Repair: The Dreaded Complication

The complication of uretero-arterial fistula after prolong ureteral stenting is well recognized. The treatment is primarily endovascular stenting across the fistulous communication accepting the potential risk of stent graft infection. Herein we present a case of a 71-year-old female who developed a...

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Bibliographic Details
Published inCurēus (Palo Alto, CA) Vol. 12; no. 6
Main Authors Perrenoud, Abby L, Heiberger, Garret, Shriver, Jackson, Yim, Douglas
Format Journal Article
LanguageEnglish
Published Palo Alto Cureus Inc 25.06.2020
Cureus
Subjects
Antibiotics
Blood
Case reports
Fistula
Hematuria
Infections
Infectious Disease
Medical imaging
Pseudoaneurysm
Radiology
Stents
Urine
Urology
Veins & arteries
United States > US
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Summary:The complication of uretero-arterial fistula after prolong ureteral stenting is well recognized. The treatment is primarily endovascular stenting across the fistulous communication accepting the potential risk of stent graft infection. Herein we present a case of a 71-year-old female who developed an uretero-arterial fistula after prolong ureteral stenting and exchanges following ileal conduit obstruction. Initial treatment with left common iliac stenting controlled the hematuria, but only temporarily. Repeat angiography revealed a type 1b endoleak requiring stent extension. Unfortunately, persistent hematuria necessitating further angiography showed the development of a saccular pseudoaneurysm around the stent graft requiring proximal stent extension. A nuclear medicine indium 111-tagged white blood cell scan with single-photon emission CT (SPECT)/CT confirmed stent graft infection. Conservative therapy with antibiotics failed, causing graft failure that ultimately required bypass surgery.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.8830