输尿管动脉瘘(UAF)是致命的疾病。然而,由于UAF的罕见性,目前尚未就其诊断和治疗达成共识.我们报告的目的是提出一个实际的UAF病例,并系统地审查症状,危险因素,诊断,和治疗这种情况。
该案例研究的对象是一名52岁的女性,她在尿道支架置换术期间经历了大出血。对于UAF研究的系统回顾,在PubMed上使用关键字“输尿管动脉瘘,动脉-输尿管瘘,“和”血尿。“
我们纳入了121项研究,涉及235名患者(平均年龄,66.0岁;139名女性[59.1%])。UAF最常见于髂总动脉(n=112;47.7%)。几乎所有患者(n=232;98.7%)都有血尿。UAF的危险因素是骨盆手术(n=205;87.2%),长期使用泌尿系统支架(n=170;72.3%),肿瘤放疗(n=107;45.5%),和恶性肿瘤(n=159;67.7%)。虽然计算机断层扫描可以检测各种有用的发现,如外渗,假性动脉瘤,肾积水,输尿管浑浊,它仅对三分之一的病例在诊断上有用。在187例接受血管造影的患者(79.6%)中,有124例(66.3%)的血管造影可用于诊断UAF。关于治疗,近年来,血管内途径已被广泛使用,因为它们的侵袭性小于开放手术修复。在血管内治疗的时代,开放性手术修复的适应症包括输尿管肠瘘,脓肿形成,血管内治疗后的移植物感染。
对于有UAF危险因素的患者,可推荐使用计算机断层扫描作为首次检查。随后,应该考虑血管造影,因为UAF可以在诊断性血管造影后使用血管内方法进行治疗.UAF的诊断和治疗通常很困难;因此,诊断的重要第一步是怀疑UAF的发生并采用多学科方法.
Ureteroarterial fistula (UAF) is lethal condition. However, no consensus has been reached regarding the diagnosis and treatment of UAF owing to its rarity. The aim of our report was to present an actual case of UAF and systematically
review the symptoms, risk factors, diagnosis, and treatment of this condition.
The case study was of a 52-year-old woman who had experienced a massive hemorrhage during urinary stent replacement. For the systematic
review of studies of UAF, those written in English and reported from 1939 to 2020 were searched for on PubMed using the keywords \"uretero-arterial fistula,\" \"arterio-ureteral fistula,\" and \"hematuria.\"
We included 121 studies with 235 patients (mean age, 66.0 years; 139 women [59.1%]) in our
review. UAF had occurred most frequently in the common iliac artery (n = 112; 47.7%). Almost all patients (n = 232; 98.7%) had complained of hematuria. The risk factors for UAF were pelvic surgery (n = 205; 87.2%), the long-term use of urinary stents (n = 170; 72.3%), oncologic radiotherapy (n = 107; 45.5%), and malignancy (n = 159; 67.7%). Although computed tomography can detect various useful findings such as extravasation, pseudoaneurysm, hydronephrosis, and opacification of ureters, it was diagnostically useful for only one third of the cases. Angiography was useful for the diagnoses of UAF for 124 (66.3%) of the 187 patients (79.6%) who had undergone angiography. With regard to treatment, endovascular approaches have been widely used in recent years because their invasiveness is lesser than that of open surgical repair. In the era of endovascular therapy, the indications for open surgical repair include ureteral-intestinal fistula, abscess formation, and graft infection after endovascular therapy.
Computed tomography can be recommended as the first examination for patients with risk factors for UAF because of its usefulness. Subsequently, angiography should be considered because UAF can be treated using an endovascular approach after diagnostic angiography. The diagnosis and treatment of UAF can often be difficult; therefore, the important first step of diagnosis is suspecting the occurrence of UAF and using a multidisciplinary approach.