Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 10013-10017
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.10013
Uretero-lumbar artery fistula: A case report
Jia-Jian Chen, Jian Wang, Qi-Gang Zheng, Zhao-Hui Sun, Jia-Cheng Li, Zi-Lei Xu, Xiao-Jun Huang
Jia-Jian Chen, Jian Wang, Qi-Gang Zheng, Zhao-Hui Sun, Jia-Cheng Li, Zi-Lei Xu, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Xiao-Jun Huang, Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
Author contributions: Chen JJ and Huang XJ conceived and wrote the report; Chen JJ and Wang J performed the operation; Zheng QG, Sun ZH, Li JC, and Xu ZL organized the data; Huang XJ revised the paper; All authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China (General Program), No. 81874400.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Jun Huang, Doctor, Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, Zhejiang Province, China. hxj258111@163.com
Received: July 2, 2021
Peer-review started: July 2, 2021
First decision: July 15, 2021
Revised: July 29, 2021
Accepted: September 10, 2021
Article in press: September 10, 2021
Published online: November 16, 2021
Processing time: 130 Days and 8.4 Hours
Abstract
BACKGROUND

Uretero-arterial fistula (UAF) is a disease that usually involves the aorta, common iliac artery, external iliac artery, hypogastric artery, and lumbar artery. Among them, uretero-lumbar artery fistula (ULAF) is the most unusual type. So, both in China and around the world, the diagnosis and treatment of ULAF is a big challenge.

CASE SUMMARY

A 55-year-old female patient with a history of pelvic radiotherapy developed unexplained massive hemorrhage during replacement of the right Resonance metallic ureteral double-J tubes due to a long-standing indwelling ureteral stent for ureteral stricture. Later, we found contrast extravasation from the patient's right L4 artery into the ureter under digital subtraction angiography (DSA) and administered polyvinyl alcohol particle embolic agent and coil embolization; hematuria was controlled. Follow-up investigations at 18 mo showed no sign of recurrence.

CONCLUSION

DSA is very important in the diagnosis and treatment of UAF, and DSA should be preferred when UAF is suspected. In addition, the use of softer ureteral stents in patients with primary disease and risk factors for UAF should be considered to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.

Keywords: Uretero-arterial fistula; Uretero-lumbar artery fistula; Hematuria; Diagnosis; Endovascular treatment; Case report

Core Tip: Uretero-arterial fistula (UAF) has an unclear etiology due to the small number of cases. Uretero-lumbar artery fistula is the least common type of UAF. We report the case of a patient with uretero-lumbar artery fistula in whom we embolized the patient's right L4 artery under digital subtraction angiography, and hematuria was controlled. This case highlights the importance of digital subtraction angiography in the diagnosis and treatment of UAF. We recommend the use of softer ureteral stents in patients with primary disease and risk factors for UAF to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.