靜脈支架術後相關髂靜脈輸尿管廔管：案例報告與文獻回顧

林宇璨¹、溫玉清¹²³

¹台北市立萬芳醫院泌尿科，²臺北醫學大學醫學系泌尿科，³臺北醫學大學泌尿腎臟研究中心

Venous stenting related iliac vein-ureteral fistula: A case report and literature review

Yu-Tsan Lin¹, Yu-Ching Wen¹²³

¹Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. ²Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. ³TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan

Introduction: Iliac vein-ureteral fistula (IVUF) is a direct fistulous communication between an iliac vein and a ureter. Compared to iliac artery-ureteral fistula (IAUF), it is more uncommon but one that can have serious consequences when not properly diagnosed and managed. The occurrence of the iliac artery/vein-ureteral fistula is often associated with degenerative iliac vessels disease or previous involvement of vessel reconstruction surgery. Additionally, its occurrence is also closely related to vascular or pelvic surgery, such as malignant tumor resection, urinary diversion, radiotherapy, ureteral stent implantation, etc.

Case summary: A 69-year-old female had history of chronic kidney disease and left fallopian tube squamous cell carcinoma status post debulking surgery and concurrent chemoradiotherapy 14 years ago. Besides, she also received bilateral iliac vein balloon angioplasty and left iliac vein stenting due to iliac vein compression syndrome 7 years ago. She suffered from recurrent left ureteral stenosis and was under long-term ureteral double J stenting since for about 11 years. Gross hematuria was found after schedule Double J stenting revision. Antergrade pyelography was checked and the iliac vein-ureteral fistula was incidentally diagnosed. Considering the atrophy of left kidney and her clinical condition, she received conservative therapy with left percutaneous nephrostomy. Fortunately, the IVUF bleeding was self-limited.

Discussion and conclusion: The pathophysiology of IVUF remains poorly understood; many factors have a potential role. Surgery, radiation therapy, venous stenting are all probably responsible for the intense fibrotic, inflammatory response that causes the ureter to attach itself to the vein. The rarity of IVUF may result in a diagnostic and treatment dilemma. The prompt and accurate diagnosis of these entities remains challenging. Treatment with endovascular repair appears to be a minimally invasive and effective option, open exploration for fistulectomy is also a definitive treatment. In our case, conservative treatment could be an option if surgical intervention was difficult and the symptoms self-limited.