Endovascular therapy of arterioureteral fistulas

Summary: Background: Arterioureteral fistulas (AUFs) are severe pathologies of different origin and with increasing incidence frequently appear in patients with underlying extensive malignancy and after pelvic surgery. AUF therapy is challenging since symptoms are frequently non-specific and patients are often unsuitable surgical candidates due to comorbidities. Since experiences with endovascular treatment strategies are limited, the feasibility, effectiveness, and safety were evaluated in a consecutive case series. Patients and methods: A retrospective analysis of five patients with endovascular AUF exclusion was performed. Probable predisposing factors for an AUF included history of pelvic malignancy with oncologic surgery in four patients, radiotherapy in four patients, and indwelling ureteral stents in four patients. Clinical presentation, diagnostic management, and site of fistula were assessed. Furthermore, technical and clinical success as well as complications were evaluated. Results: All patients presented with gross haematuria. In four patients, haematuria occurred during endoscopic ureteral stent manipulation. Affected vessels were the internal pudendal artery in one, intrarenal segmental artery and external iliac artery in two, and internal iliac artery in another two patients. Treatment included coil embolisation (n = 2), plug embolisation (n = 3), particulate embolisation (n = 1), and covered stent implantation (n = 2). Technical success was achieved in all procedures. In two cases, re-intervention was necessary due to AUF recurrence, resulting in a clinical success rate of 60.0%. One major complication class D was documented. Conclusions: AUFs can be treated effectively and safely using endovascular techniques. Diagnostic and therapeutic management of this rare entity requires a high level of awareness for potential risk factors as well as an optimal multidisciplinary coordination.

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Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature

CVIR Endovascular ◽

10.1186/s42155-021-00226-6 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Bjoern Simon ◽

Jakob Neubauer ◽

Martin Schoenthaler ◽

Simon Hein ◽

Fabian Bamberg ◽

...

Keyword(s):

Endovascular Therapy ◽

Iliac Artery ◽

Coil Embolization ◽

Clinical Success ◽

Hypovolemic Shock ◽

Case Series ◽

Pelvic Surgery ◽

Review Of The Literature ◽

Single Center

Abstract Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment. Methods This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management. Results We identified 17 UAF in 16 patients (12 male, 4 female, mean age 69.8 ± 11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1–3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases (82.4%). Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%). Conclusion Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary. Evidence-based medicine Level 4, case series.

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Prospective study of the E-liac Stent Graft System in patients with common iliac artery aneurysms: 30-Day results

Vascular ◽

10.1177/1708538118789510 ◽

2018 ◽

Vol 26 (6) ◽

pp. 647-656 ◽

Cited By ~ 3

Author(s):

Jan Brunkwall ◽

Carlos Vaquero Puerta ◽

Joerg Heckenkamp ◽

Jose Maria Egaña Barrenechea ◽

Piotr Szopinski ◽

...

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Common Iliac Artery ◽

Clinical Success ◽

Clinical Success Rate ◽

External Iliac Artery ◽

Aortic Stent Graft ◽

Type Ia ◽

Internal Iliac

Objectives To study the safety and feasibility of the E-liac Stent Graft System® in patients with aorto/iliac aneurysms. Methods A prospective multicentric European registry of patients receiving the E-liac Stent Graft System® was conducted. Endpoints of the study included the technical success as well as periprocedural events and 30-day endoleaks, reinterventions, internal and external iliac artery patency and mortality. Results Between July 2014 and June 2016, a total of 45 patients (93% men, mean age 72 years, range 53–90 years) were enrolled at 11 sites in four European countries. Five patients received an isolated iliac treatment. Thirty-seven patients were treated with a combination of an abdominal stent graft and a unilateral E-liac and three in combination with bilateral E-liac. All E-liac Stent Grafts (48) were implanted in the intended position and the internal iliac arteries were successfully bridged. Two patients did not receive clinical success, due to endoleak type Ia of the aortic stent graft. At 30-day follow-up, clinical success rate was 96%. Three successful endovascular reinterventions were performed within the 30-day follow-up: one due to a type Ia endoleak in the common iliac artery, one due to type Ia endoleak of the aortic stent graft, and one due to bilateral lower limb claudication provoked by stent graft limb stenosis. At 30-day, a 100% survival rate and complete absence of pelvic or buttock ischemia/claudication were reported. Primary patency at 30 days was 100% for the internal iliac artery and 98% for the external iliac artery with an assisted patency of 100% in the latter. Conclusions The high clinical success rate, low rates of device-related reinterventions (2%), and excellent patency rate demonstrate the safety and feasibility of the E-liac Stent Graft System. Long-term results are awaited to state efficacy and durability. Clinical Trials.gov. Identifier no. NCT02209194.

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Palliative Endoscopic Ultrasound Biliary Drainage for Advanced Malignant Biliary Obstruction: Should It Replace the Percutaneous Approach?

Case Reports in Gastroenterology ◽

10.1159/000502835 ◽

2019 ◽

Vol 13 (3) ◽

pp. 385-397 ◽

Cited By ~ 1

Author(s):

C. Rinaldi A. Lesmana ◽

Rino A. Gani ◽

Irsan Hasan ◽

Andri Sanityoso Sulaiman ◽

Khek Yu Ho ◽

...

Keyword(s):

Success Rate ◽

Endoscopic Ultrasound ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Clinical Success ◽

Case Series ◽

Clinical Success Rate ◽

Malignant Biliary Obstruction ◽

Technical Success Rate ◽

Case Series Study

Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are the standard of care in malignant biliary obstruction cases. Recently, endoscopic ultrasound-guided biliary drainage (EUS-BD) has been widely used after unsuccessful ERCP. However, the patient’s clinical impact of EUS-BD over PTBD is still not obvious. Therefore, this case series study aims to evaluate the clinical outcomes of patients with advanced malignant biliary obstruction who underwent EUS-BD after failed ERCP. A retrospective database study was performed between January 2016 and June 2018 in patients with advanced malignant biliary obstruction. Patients were consecutively enrolled without randomization. Treatment options consisted of ERCP and PTBD or EUS-BD if ERCP failed. Based on 144 biliary obstruction cases, 38 patients were enrolled; 24 (63.2%) were men. The patients’ mean age was 66.8 ± 12.36 years. The most common cause of malignant biliary obstruction was pancreatic cancer (44.7%). Biliary drainage was achieved by ERCP (39.5%), PTBD (39.5%), and EUS-BD (21.1%). The technical success rate was 86.7% by PTBD and 87.5% by EUS-BD (p = 1.000), while the clinical success rate was 93.3% by PTBD and 62.5% by EUS-BD (p = 0.500). The median survival in patients who underwent PTBD versus those wo underwent EUS-BD was 11 versus 3 months (log-rank p = 0.455). In conclusion, there is no significant advantage of EUS-BD when compared to PTBD in terms of clinical success and survival benefit in advanced malignant biliary obstruction.

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The need for post-operative vasopressor infusions after major gynae-oncologic surgery within an ERAS (Enhanced Recovery After Surgery) pathway

Perioperative Medicine ◽

10.1186/s13741-020-00158-0 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Michèle Bossy ◽

Molly Nyman ◽

Thumuluru Kavitha Madhuri ◽

Anil Tailor ◽

Jayanta Chatterjee ◽

...

Keyword(s):

Blood Loss ◽

Epidural Analgesia ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Case Series ◽

Pelvic Surgery ◽

Oncologic Surgery ◽

Factors Associated ◽

Estimated Blood Loss ◽

Morbidity Score

Abstract Background Hypotension following major abdominal surgery is common, and once hypovolaemia has been optimally treated, is often due to vasodilation which can be treated with vasopressor infusions. There is unpredictability in the dose and duration of post-operative vasopressor infusions, and factors associated with this have not been determined. Methods We present a case series of consecutive patients who received major gynae-oncology surgery delivered within an Enhanced Recovery After Surgery (ERAS) pathway at a single institution. Patients were electively admitted from theatre directly to the intensive care unit (ICU). Data was collected prospectively into electronic databases (Philips ICCA, Wardwatcher) and then retrospectively collated and appropriate statistical analyses were performed. In the absence of a consensus definition of vasoplegia, we, necessarily arbitrarily, chose a noradrenaline dose of > 0.1 mcg/kg/min at 08:00 on the first post-operative day. The rationale is that this would be more than would typically be expected to counteract the vasodilatory effects of epidural analgesia, which is commonly used at our institution. Results Data was collected from 324 patients, all treated between February 2014 and July 2016. The average age was 67 years and 39% received neoadjuvant chemotherapy. The commonest tumour type was ovarian (58%). The median estimated blood loss was 800 ml and epidural analgesia was used in 71%. Fifty per cent received post-operative vasopressor infusions: factors associated with this included epidural use and estimated blood loss. Nineteen per cent met our criteria for vasoplegia: factors associated with this included CRP on post-operative day 1 and P-POSSUM morbidity score. Hospital and ICU length of stay was prolonged in those who had vasoplegia. Conclusions Patients commonly receive vasopressors following major gynae-oncologic surgery, and this can be at relatively high doses. Clinical factors only accounted for a minority of the variability in vasopressor usage—suggesting considerable biological variability. Optimal care of patients having major abdomino-pelvic surgery may include advanced haemodynamic monitoring and ready availability of infused vasopressors, in a suitable environment.

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Remote Iliac Artery Endarterectomy: A Case Series and Systematic Review

Journal of Endovascular Therapy ◽

10.1177/1526602817749620 ◽

2018 ◽

Vol 25 (1) ◽

pp. 140-149 ◽

Cited By ~ 1

Author(s):

Joost A. Bekken ◽

Sanne W. de Boer ◽

Rogier van der Sluijs ◽

Hidde Jongsma ◽

Jean-Paul P. M. de Vries ◽

...

Keyword(s):

Systematic Review ◽

Treatment Option ◽

Iliac Artery ◽

English Language ◽

Case Series ◽

External Iliac Artery ◽

Primary Patency ◽

Long Term Results ◽

Secondary Patency

Purpose: To evaluate the long-term results of remote iliac artery endarterectomy (RIAE) in 2 vascular referral centers and review existing literature. Methods: A retrospective analysis was conducted of 109 consecutive patients (mean age 64.2±10.7 years; 72 men) who underwent 113 RIAE procedures for lower limb ischemia from January 2004 to August 2015 at 2 vascular centers. The majority of limbs (82, 72.6%) had TASC II D lesions (31 TASC II C). Primary outcome measures were primary, assisted primary, and secondary patency. A comprehensive literature search was performed in the PubMed and EMBASE databases to identify all English-language studies published after 1990 reporting the results of RIAE. Results: Technical success was achieved in 95 (84.1%) of the 113 procedures. The complication rate was 13.7%, and 30-day mortality was 0%. At 5 years, primary patency was 78.2%, assisted primary patency was 83.4%, and secondary patency was 86.7%. Hemodynamic success was obtained in 91.7% of patients, and clinical improvement was observed in 95.2%. Freedom from major amputation was 94.7% at 5 years. The systematic review comprised 6 studies including 419 RIAEs, and pooled data showed results similar to the current study. Conclusion: For external iliac artery occlusions extending into the common femoral artery, RIAE appears to be a valuable hybrid treatment option. It combines acceptable morbidity and low mortality with good long-term patency. It has some advantages over an open surgical iliofemoral bypass or complete endovascular revascularization and could be the best treatment option in selected cases.

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Intra-Arterial Prostaglandin E1Infusion in Patients with Rest Pain: Short-Term Results

The Scientific World JOURNAL ◽

10.1100/2012/803678 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

A. Chatziioannou ◽

A. Dalakidis ◽

K. Katsenis ◽

V. Koutoulidis ◽

D. Mourikis

Keyword(s):

Iliac Artery ◽

Clinical Success ◽

External Iliac Artery ◽

Infusion Therapy ◽

Rest Pain ◽

Port Catheter ◽

Short Term ◽

Intraarterial Infusion ◽

Group A ◽

Group B

Purpose. To present our results after short-term (1 month) intra-arterial infusion therapy of PGE1-alprostadil via a port system implanted in the ipsilateral external iliac artery (EIA) in patients with severe rest pain.Methods. Ten patients with severe rest pain were included. All patients showed extensive peripheral vascular disease below the knee. The tip of the catheter was introduced via a retrograde puncture in the ipsilateral external iliac artery (EIA). The patients received intraarterial infusion of PGE1, 20 mgr alprostadil daily, via the port catheter for 1 month.Results. Clinical success was evaluated according to subjective grading of pain (group A significant decrease, group B moderate decrease and group C no response). A significant decrease of rest pain was observed in 8 (group A, 80%) patients, a moderate decrease in 2 (Group B, 20%), whereas no patients demonstrated any significant response. Both patients of group B had Buergers' disease and continue to smoke during therapy. No peripheral thrombosis or clinical deterioration was noticed.Conclusion. Intraarterial infusion of PGE1alprostadil on a daily basis, using a port catheter into the ipsilateral EIA, in selected patients with severe rest pain, seems to be very effective, without any serious complications.

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Amplatzer occluders for refractory esophago-respiratory fistulas: a case series

Endoscopy International Open ◽

10.1055/a-1490-9001 ◽

2021 ◽

Vol 09 (09) ◽

pp. E1350-E1354

Author(s):

Arthur Belle ◽

Christine Lorut ◽

Aurélie Lefebvre ◽

Einas Abou Ali ◽

Rachel Hallit ◽

...

Keyword(s):

Primary Outcome ◽

Clinical Success ◽

Case Series ◽

Clinical Success Rate ◽

Endoscopic Management ◽

Vacuum Therapy ◽

Short Term ◽

Endoscopic Vacuum Therapy ◽

Endoscopic Placement ◽

Safe Treatment Option

Abstract Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.

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Results of Endovascular Therapy of Ureteroarterial Fistulas: A Single Center Experience

10.21203/rs.3.rs-266941/v1 ◽

2021 ◽

Author(s):

Bjoern Simon ◽

Jakob Neubauer ◽

Martin Schoenthaler ◽

Simon Hein ◽

Fabian Bamberg ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Therapy ◽

Iliac Artery ◽

Coil Embolization ◽

Clinical Success ◽

Hypovolemic Shock ◽

Case Series ◽

Single Center ◽

Single Center Experience

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Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery

Emergency Radiology ◽

10.1007/s10140-021-01971-w ◽

2021 ◽

Author(s):

Koji Sasaki ◽

Takuya Okada ◽

Masato Yamaguchi ◽

Mostafa Ahmed ◽

Tomoyuki Gentsu ◽

...

Keyword(s):

Vaginal Delivery ◽

Iliac Artery ◽

Transcatheter Arterial Embolization ◽

Postpartum Hemorrhage ◽

Genital Tract ◽

Internal Iliac Artery ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Internal Iliac

Abstract Purpose To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. Methods We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. Results The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). Conclusion S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

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Use of microspheres in embolization for unruptured renal angiomyolipomas

Open Medicine ◽

10.1515/med-2021-0280 ◽

2021 ◽

Vol 16 (1) ◽

pp. 655-659

Author(s):

Masashi Shimohira ◽

Keiichi Nagai ◽

Kengo Ohta ◽

Yusuke Sawada ◽

Taku Naiki ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Major Complication ◽

Shrinkage Rate ◽

Technical Success ◽

Technical Success Rate ◽

Major Complication Rate

Abstract Purpose To describe our initial experience with use of microspheres in transcatheter arterial embolization (TAE) for unruptured sporadic renal angiomyolipomas (AMLs). Materials and methods Seven consecutive patients with seven unruptured sporadic renal AMLs, 6 females and 1 male, with a median age of 45 years (range, 30–69 years), underwent TAE using microspheres between November 2016 and February 2020. We evaluated the technical success rate, complications related to the procedure, clinical success rate, and the shrinkage rate of renal AML. Technical success was defined as the completion of TAE. Clinical success was defined as presence of shrinkage of the renal AML after TAE. Results In all patients, TAE using microspheres was accomplished and technical success rate was 100% (7/7). Three patients exhibited slight pain, but it improved with only observation, and the minor complication rate was 43% (3/7) and major complication rate was 0% (0/7). After the TAE, shrinkage of renal AML was confirmed in 6 of 7 patients, and clinical success rate was 86% (6/7). The median of shrinkage rate was 47% (range, 26–83%) with a median follow-up period of 19 months (range, 4–30 months). Conclusion TAE using microspheres appears to be effective and safe for unruptured sporadic renal AMLs.

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