DIAGNOSIS AND MANAGEMENT OF URETEROILIAC ARTERY FISTULA - VALUE OF PROVOCATIVE ARTERIOGRAPHY FOLLOWED BY COMMON ILIAC ARTERY EMBOLIZATION AND EXTRAANATOMIC ARTERIAL BYPASS-GRAFTING

Purpose: We describe an effective multidisciplinary approach to the di agnosis and management of ureteroarterial fistulas that reduces morbid ity and mortality. Materials and Methods: Five ureteroarterial fistula s in 4 patients mere studied with standard and provocative arteriograp hy (arteriography combined with ureteral manipulation). After establis hing the diagnosis, each lesion was treated with percutaneous embolic occlusion of the common iliac artery followed by extraanatomic arteria l bypass grafting. All patients had chronic ureteral stenting, prior p elvic irradiation, prior pelvic surgery and intrapelvic malignancy, an d all fistulas presented with urinary tract hemorrhage. Results: Stand ard arteriography was nondiagnostic but provocative arteriography demo nstrated the fistula in each case. Successful embolization of the comm on iliac artery followed by extraanatomic arterial bypass grafting pre cluded the need for laparotomy and preserved ipsilateral renal functio n. Conclusions: Provocative arteriography followed by arteriographic c ommon iliac artery embolization and extraanatomic bypass grafting was successful for the diagnosis and treatment of ureteroarterial fistulas . There was no mortality, limb loss or renal loss.