A Case of Granulomatosis with Polyangiitis Causing Hydroureter and Hydronephrosis

Granulomatosis with Polyangiitis (GPA, formerly known as Wegener) is a systemic vasculitis characterized by granulomatous involving upper and lower respiratory tract and can also cause necrotizing glomerulonephritis (Umemoto et al. 2012 and Takala et al. 2011). GPA is associated with antineutrophil cytoplasmic autoantibodies (ANCA) against serine proteinase 3 (PR3) (Takala et al. 2011, Dufour et al. 2012, and Berthoux et al. 2011). This disease usually starts with involvement of the upper and lower respiratory tracts and also can involve kidney, eyes, skin, central and peripheral nervous systems, and gastrointestinal tract (Umemoto et al. 2012, Takala et al. 2011, and Berthoux et al. 2011). We describe a case of GPA that presented with abdominal pain. Computed tomography (CT) scan with contrast showed right sided moderate hydronephrosis and hydroureter, to the level of the right common iliac artery. There was also mural segmental thickening in common iliac artery which was thought to be the cause of the ureteral obstruction and hydronephrosis. Our case shows that mural segmental thickening in common iliac artery happened due to GPA and caused hydronephrosis. In addition, most of the cases with hydronephrosis due to GPA went through urology intervention such as stent placement but in our case hydronephrosis resolved with medical management.

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Post-operative internal hernia through an orifice underneath the right common iliac artery after Dargent’s operation

Hernia ◽

10.1007/s10029-013-1129-0 ◽

2013 ◽

Vol 18 (6) ◽

pp. 907-909 ◽

Cited By ~ 12

Author(s):

M. Ardelt ◽

Y. Dittmar ◽

H. Scheuerlein ◽

E. Bärthel ◽

U. Settmacher

Keyword(s):

Iliac Artery ◽

Internal Hernia ◽

Common Iliac Artery ◽

The Right ◽

Dargent’S Operation

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Primary Mycotic Aneurysm of the Right Common Iliac Artery

Archives of Surgery ◽

10.1001/archsurg.1968.01330210051009 ◽

1968 ◽

Vol 96 (3) ◽

pp. 373 ◽

Cited By ~ 9

Author(s):

Mario M. Labardini

Keyword(s):

Iliac Artery ◽

Mycotic Aneurysm ◽

Common Iliac Artery ◽

The Right

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Iliocaval Compression Syndrome

Phlebology The Journal of Venous Disease ◽

10.1177/026835558700200310 ◽

1987 ◽

Vol 2 (3) ◽

pp. 173-179 ◽

Cited By ~ 5

Author(s):

Syde A. Taheri ◽

Paul Nowakowski ◽

David Pendergast ◽

Julie Cullen ◽

Steve Pisano ◽

...

Keyword(s):

Iliac Artery ◽

Common Iliac Artery ◽

Vena Cava ◽

Signs And Symptoms ◽

Iliac Vein ◽

Venous Hypertension ◽

Common Iliac Vein ◽

Compression Syndrome ◽

Extrinsic Compression ◽

The Right

The iliocaval compression syndrome is a disorder, frequently found in young women, in which extrinsic compression of the left iliocaval junction produces signs and symptoms of lower extremity venous insufficiency. The anatomic variant which gives rise to this syndrome consists of compression of the left common iliac vein by the overlying right common iliac artery, near its junction with the vena cava. Additional reduction of outflow results from intraluminal venous webs and tight adhesions between the iliac artery and vein. Pain, swelling, pigmentation, and venous claudication characterize this syndrome, which affects predominantly the left leg. The syndrome may progress to iliofemoral thrombosis, phlegmasia cerulea dolens, and venous gangrene. Longstanding iliocaval stenosis may produce valvular incompetence. Exercise plethysmography is a non-invasive test useful in screening patients for iliocaval compression. The definitive diagnosis is made by venography, both ascending and descending, to determine the degree of outflow stenosis. Iliocaval patch angioplasty with retrocaval positioning of the right iliac artery, decreases venous hypertension and leads to improvement in the clinical condition. To date, we have performed iliocaval angioplasty, with retrocaval repositioning of the right common iliac artery, on 18 patients. Of these, 83% have had good results as determined by hemodynamic and clinical assessment.

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Clinical features of ANCA-associated vasculitis

Oxford Textbook of Rheumatology ◽

10.1093/med/9780199642489.003.0131_update_001 ◽

2013 ◽

pp. 1090-1102

Author(s):

Wolfgang L. Gross ◽

Julia U. Holle

Keyword(s):

Respiratory Tract ◽

Clinical Features ◽

Lower Respiratory Tract ◽

Granulomatosis With Polyangiitis ◽

Systemic Vasculitis ◽

Systemic Disease ◽

Clinical Signs ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Granulomatous Lesions ◽

Organ Manifestations

The primary ANCA-associated vasculitides are granulomatosis with polyangiitis (Wegener’s, GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome, CSS). They predominantly affect small (and medium-sized) vessels and share a variable association with ANCA (anti-neutrophil cytoplasm antibody) directed against neutrophil proteinase 3 (PR3, mainly in GPA) and myeloperoxidase (MPO, mainly in MPA and CSS). Crescentic necrotizing glomerulonephritis and alveolar haemorrhage due to pulmonary capillaritis represent classical (vasculitic) organ manifestations of the ANCA-associated vasculitides (AAV). MPA occurs as a ’pure’ small (to medium-size) vessel vasculitis, whereas GPA and CSS are characterized by additional distinct clinical and pathological features. In GPA, granulomatous lesions of the upper and/or lower respiratory tract are a hallmark of the disease. Granulomatous lesions may be large in appearance and occur as space-consuming, infiltrating, and destructive inflammatory masses. GPA is believed to follow a stagewise course with an initial localized form, restricted granulomatous lesions of the upper and/or lower respiratory tract without clinical signs of vasculitis, and a consecutive generalization to systemic vasculitis which may be either non-organ-threatening (early systemic) or organ- and life- threatening (generalized GPA). Rarely, patients arrest in the localized stage and do not progress to systemic disease. In EGPA asthma, hypereosinophilia and eosinophilic organ infiltration (e.g. eosinophilic myocarditis) are typical features of the disease apart from vasculitis. Similarly to GPA, EGPA follows a stagewise course: asthma and eosinophilia may precede full-blown disease for several months or years. Recent cohort studies suggest different phenotypes in EGPA (predominantly vasculitic and MPO-ANCA-positive and predominantly with eosinophilic organ infiltration, usually ANCA-negative). This chapter focuses on the clinical features of the primary AAV and their outcome.

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Ureteral iliac artery fistula in idiopathic retroperitoneal fibrosis: A case report

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.2.107 ◽

2020 ◽

Vol 92 (2) ◽

Author(s):

Eugenio Di Grazia ◽

Tiziana La Malfa ◽

Gherardo Gasso

Keyword(s):

Iliac Artery ◽

Retroperitoneal Fibrosis ◽

Common Iliac Artery ◽

Unknown Etiology ◽

Gross Hematuria ◽

Idiopathic Retroperitoneal Fibrosis ◽

First Case ◽

Life Threatening ◽

Uncommon Condition ◽

The Right

Ureter-arterial fistula (UAF) is an uncommon condition. The presentation is usually a life-threatening intermittent massive gross hematuria and the diagnosis is still a challenge for urologist. Idiopathic Retroperitoneal fibrosis (IRF) is a condition of unknown etiology characterized by a highly fibrotic retroperitoneal mass that frequently causes ureteral obstruction. To our knowledge we report the first case describing the UAF in a patient suffering from IRF. We hypothesize that inflammation and fibrosis resulted in fixation of the ureter to the adjacent artery causing a fistulous path. UAF was managed by deploying a 10 x 59 mm endo-graft at the intersection of common iliac artery bifurcation with the right ureter. Post treatment course was uneventful.

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Clinical features of ANCA-associated vasculitis

10.1093/med/9780199642489.003.0131 ◽

2013 ◽

Author(s):

Wolfgang L. Gross ◽

Julia U. Holle

Keyword(s):

Respiratory Tract ◽

Clinical Features ◽

Lower Respiratory Tract ◽

Granulomatosis With Polyangiitis ◽

Systemic Disease ◽

Alveolar Haemorrhage ◽

Medium Size ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Necrotizing Glomerulonephritis ◽

Granulomatous Lesions

The primary ANCA-associated vasculitides are granulomatosis with polyangiitis (Wegener's, GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome, CSS). They predominantly affect small (and medium-sized) vessels and share a variable association with ANCA (anti-neutrophil cytoplasm antibody) directed against neutrophil proteinase 3 (PR3, mainly in GPA) and myeloperoxidase (MPO, mainly in MPA and CSS). Crescentic necrotizing glomerulonephritis and alveolar haemorrhage due to pulmonary capillaritis represent classical (vasculitic) organ manifestations of the ANCA-associated vasculitides (AAV). MPA occurs as a 'pure' small (to medium-size) vessel vasculitis, whereas GPA and CSS are characterized by additional distinct clinical and pathological features. In GPA, granulomatous lesions of the upper and/or lower respiratory tract are a hallmark of the disease. Granulomatous lesions may be large in appearance and occur as space-consuming, infiltrating, and destructive inflammatory masses. GPA is believed to follow a stagewise course with an initial localized form, restricted granulomatous lesions of the upper and/or lower respiratory tract without clinical signs of vasculitis, and a consecutive generalization to systemic vasculitis which may be either non-organ-threatening (early systemic) or organ- and life- threatening (generalized GPA). Rarely, patients arrest in the localized stage and do not progress to systemic disease. In EGPA asthma, hypereosinophilia and eosinophilic organ infiltration (e.g. eosinophilic myocarditis) are typical features of the disease apart from vasculitis. Similarly to GPA, EGPA follows a stagewise course: asthma and eosinophilia may precede full-blown disease for several months or years. Recent cohort studies suggest different phenotypes in EGPA (predominantly vasculitic and MPO-ANCA-positive and predominantly with eosinophilic organ infiltration, usually ANCA-negative). This chapter focuses on the clinical features of the primary AAV and their outcome.

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Two Stage Complex Embolization of an Arteriovenous Fistula between the Right Common Iliac Artery and the Inferior Vena Cava

Journal of Radiology Case Reports ◽

10.3941/jrcr.v3i1.57 ◽

2009 ◽

Vol 3 (1) ◽

Author(s):

Marc Gingell Littlejohn ◽

Nile Allaf ◽

Stephen Butterfield

Keyword(s):

Inferior Vena Cava ◽

Arteriovenous Fistula ◽

Iliac Artery ◽

Inferior Vena ◽

Common Iliac Artery ◽

Vena Cava ◽

Two Stage ◽

The Right

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Secondary Relining With Focal Flaring of Novel-Generation Balloon-Expandable Covered Stents for Endovascular Treatment of Significant Diameter Mismatch in the Aorto-Iliac Territory

Vascular ◽

10.1177/1708538120945056 ◽

2020 ◽

pp. 170853812094505

Author(s):

Mario D’Oria ◽

Filippo Griselli ◽

Davide Mastrorilli ◽

Filippo Gorgatti ◽

Silvia Bassini ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Stent Graft ◽

Iliac Artery ◽

Common Iliac Artery ◽

Covered Stents ◽

Abdominal Aortic ◽

The Right

Objectives The aim of this study was to report on the safety and feasibility of secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory. Significant diameter mismatch was defined as >20% difference in the nominal diameter between the intended proximal and distal landing zones. Methods Patient A was an 84-year-old man with prior abdominal aortic aneurysm open repair with a straight 20 mm Dacron tube. He presented with a right common iliac artery aneurysm (Ø88 mm) with contained rupture. The Gore Viabahn endoprosthesis (9 mm × 5 cm) was inserted proximally about 15 mm above the occluded ostium of the internal iliac artery. Subsequently, the BeGraft Aortic® (16 mm × 48 mm) was inserted proximally up to the common iliac artery origin; its proximal portion was flared to 22 mm. Patient B was a 77-year-old man with prior endovascular abdominal aortic aneurysm repair with a Medtronic Endurant stent-graft. He presented with occlusion of the right limb of the aortic endoprosthesis and thrombosis that extended down to the level of the superficial femoral artery. After mechanical thrombectomy, two Gore Viabahn endoprosthesis (first one, 8 mm × 10 cm; second one, 10 mm × 15 cm) were inserted into the right iliac limb. Subsequently, the BeGraft Aortic® (12mm × 39mm) was inserted proximally up to the gate of the aortic stent-graft; its proximal portion was flared to 16 mm. Results Technical success and clinical success were achieved in both patients. Imaging follow-up (6 months for Patient A, 12 months for Patient B) showed correct placement of all stent-grafts without any graft-related adverse event. The patients remained free from new reinterventions or recurrent symptoms. Patient A died 8 months after the index procedure from acute respiratory failure after community acquired pneumonia. Conclusion Secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory is safe and feasible. Although mid-term results seem to be effective, longer follow-up is warranted to establish durability of the technique.

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