Abstract
A 79-year-old man who had undergone aneurysmectomy and graft replacement for an abdominal aortic aneurysm developed abdominal distension and massive hematuria. A computed tomography (CT) scan revealed the presence of anastomotic pseudoaneurysms and an ureteroarterial fistula between the ureter and iliac artery (distal anastomotic pseudoaneurysm). On admission, the patient's vital signs were stable. The patient was considered a high-risk case for open surgery because of his renal dysfunction which required dialysis, chronic heart failure and hostile abdomen. We initially recommended open surgery because of possible graft infection, however, the patient refused to undergo the high-risk open surgery. We performed emergency surgery for the ureteroarterial fistula via coverage with off-label use of the stent-graft leg. Intraoperative angiography revealed that there was no leakage. After 1 month, we confirmed that the inflammatory laboratory data was normalized, subsequently, we performed endovascular re-intervention for the proximal aortic anastomotic pseudoaneurysm. The endoleak was finally repaired after off-label use of the stent-graft (aortic cuff exclusion) twice within 2 months. The patient did not develop any operation-related adverse events for 4 months, but subsequently he died of pneumonia that developed from a common cold. Thus, we successfully performed endovascular treatment for a high-risk patient with an ureteroarterial fistula and pseudoaneurysms, without any surgery-related infection.
