血管内ステントグラフト留置により止血修復し得た尿管動脈瘻の1例

Abstract

76歳男.浸潤性膀胱癌に対して膀胱全摘除術ならびに回腸導管造設術を施行され, 術後, 左尿管回腸吻合部縫合不全および創感染があり, 左尿管にシングルJ尿管カテーテルを留置し保存的に治療した.しかし, 突然にストマより血尿, 血塊の排出を認め, カテーテルを再留置し止血を行ったがその後も間歇的に動脈性出血が続き, 左腎盂腎炎を併発した.膀胱癌手術, 尿管カテーテル長期留置, 間歇的動脈性出血などから尿管動脈瘻の可能性が高いと判断し, 左経皮的腎瘻造設術を施行した.術後に出血量の増加を認め, 骨盤動脈造影検査および血管内ステントグラフト留置術による止血・瘻孔修復を行った.術後経過は良好であり, 10ヵ月経過の現在, 血管内ステントグラフト位置に変化なく, 疎通性は良好であり, 合併症は認めていない

We report a case of ureteral-iliac artery fistula and its minimally invasive management with endovascular stent grafting. A 76-year-old male was admitted with massive gross hematuria from an ilial conduit. He underwent a radical cystectomy with ileal loop urinary diversion for bladder cancer 7 months ago and had undergone placement of a 7 Fr single-J ureteral catheter for repair of a partial disruption of the left ureteroileal anastomosis. Although the fistula was not confirmed radiographically, a left ureteral-common iliac artery fistula was highly suspected. The patient was treated by percutaneous placement of an autoexpandable covered stent graft across the left common iliac and left external iliac artery. After successful endovascular management of the ureteroarterial fistula, the patient's hematuria resolved and he recovered fully. During 10 months of follow up, he has been free of hemorrhagic episodes. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide a safety treatment alternative.