Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2019

Open Access 01-12-2019 | Hematuria | Case report

Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report

Authors: Luan Jaha, Vlora Ismaili-Jaha, Bekim Ademi, Fahredin Veselaj, Destan Kryeziu, Bujar Gjikolli, Agreta Gecaj-Gashi, Adhurim Koshi, Art Jaha

Published in: Journal of Medical Case Reports | Issue 1/2019

Login to get access

Abstract

Introduction

Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter.

Case presentation

We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up.

Conclusion

The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery remains the best treatment option, although there is increasing evidence of successful endovascular treatment.
Literature
1.
2.
van den Bergh RC, Moll FL, de Vries JP, Yeung KK, Lock TM. Arterio-ureteral fistula: 11 new cases of a wolf in sheep’s clothing. J Urol. 2008;179:578–81.PubMedCrossRef
3.
Seitz M, Waggershauser T, Khoder W. Congenital intrarenalarteriovenous malformation presenting with gross hematuria after endoscopic intervention: a case report. J Med Case Rep. 2008;2:326.PubMedPubMedCentralCrossRef
4.
Carrafiello G, Laganà D, Peroni G, Mangini M, Fontana F, Mariani D, Piffaretti G, Fugazzola C. Gross hematuria caused by a congenital intrarenal arteriovenous malformation: a case report. J Med Case Rep. 2011;5:510.PubMedPubMedCentralCrossRef
5.
Sountoulides P, Zachos I, Paschalidis K, Asouhidou I, Fotiadou A, Bantis A, Palasopoulou M, Podimatas T. Massive hematuria due to a congenital renal arteriovenous malformation mimicking a renal pelvis tumor: a case report. J Med Case Rep. 2008;2:144.PubMedPubMedCentralCrossRef
6.
Van den Bergh RCN, Moll FL, De Vries JPPM, Lock TMTW. Arterioureteral fistulas: unusual suspects – a systematic review of 139 cases. Urology. 2009;74:251–5.PubMedCrossRef
7.
Mitterberger M, Frauscher F, Steppan I, Peschel R, Pinggera GM. Ureteroiliac fistula: a case report review of the literature. Cases J. 2009;2:62–6.CrossRef
8.
Oliveira N, Oliveria F, MotaPreto P, Cassio I. A primary arterial–ureteral fistula after anaorticbifemoral bypass. Int J Surg Case Rep. 2013;4(1):48–50.PubMedCrossRef
9.
Marković DM, Davidović LB, Kostić DM, Maksimović ZV, Cinara IS, Cvetković SD, Marković MD, Dragas MV. Anastomotic pseudoaneurysms [in Serbian]. Srp Arh Celok Lek. 2006;134(3–4):114–21.PubMedCrossRef
10.
Kim GE, Imporato AM, Nathan I, Riels TS. Dilatation of synthetic grafts and junctional aneurysms. Arch Surg. 1979;114:1296–303.CrossRef
11.
12.
Szilagyi DE, Smith RF, Elliot JP, et al. Anastomotic aneurysms after vascular reconstruction: problems of incidence, etiology and treatment. Surgery. 1975;78(6):800–16.PubMed
13.
Watanabe T, Kusaba A, Kuma H, et al. Failure of Dacron arterial prostheses caused by structural defect. J Cardiovasc Surg. 1983;24:95–100.
14.
Clark ET, Gewertz BL. Pseudoaneurysms. In: Rutherford RB, editor. Vascular surgery. 4th ed. Philadelphia: Saunders; 1994. p. 1153–61.
15.
Gutman H, Zelinovski A, Reiss R. Ruptured anastomotic pseudoaneurysms after prosthetic vascular graft bypass procedures. J Med Sci. 1984;20(7):613–7.
16.
Broyn T, Christensen O, Fossdal JE, Kordit KF, Kroese A, Myhre HO. Early complications with a new bovine arterial graft (Solcograft P). Acta Chir Scand. 1986;152:263–6.PubMed
17.
Mulder EJ, van Bockel JH, Maas J, van den Akker PJ, Hermans J. Morbidity and mortality of reconstructive surgery of noninfected false aneurysms detected long after aortic prostetic reconstruction. Arch Surg. 1998;133(1):45–9.PubMedCrossRef
18.
DeBakey ME, Crawford ES, Morris GC, Cooley LA. Patch graft angioplasty in vascular surgery. J Cardiovasc Surg. 1963;3:106–41.
19.
Tridico F, Zan S, PanierSuffat P, Contessa L, Bruno F, Caldart M. Femoral anastomotic pseudoaneurysms: the etiopathogenetic hypotheses and the therapy. Minerva Chir. 1992;47(1–2):37–40.PubMed
20.
Morbidelli A, Caron R, Caldana G, Musazzi M, Capobianco M, Florianello F. Bilateral thrombosis of a femoral pseudoaneurysm. Minerva Chir. 1995;50(11):1013–8.PubMed
21.
Levi N, Schroeder TV. Anastomotic femoral aneurysms: increase in interval between primary operation and aneurysm formation. Eur J Vasc Endovasc Surg. 1996;11:207–9.PubMedCrossRef
22.
23.
Nichols WK, Stanton M, Silver D, Keitzer WF. Anastomotic aneurysms following lower extremity revascularization. Surgery. 1980;88:366–74.PubMed
24.
Sedwitz MM, Hye RJ, Stabile BE. The changing epidemiology of pseudoaneurysms: therapeutic implantations. Arch Surg. 1988;123:473–6.PubMedCrossRef
25.
26.
Dorros G, Jaff MR, Parikh A, et al. In vivo crushing of an aortic stent enables endovascular repair of a large infrarenal aortic pseudoaneurysm. J Endovasc Surg. 1998;5(4):359–64.PubMedCrossRef
27.
Merrill EW, Salzam EW. Properties of material affecting the behavior of blood art their surfaces. In: Sawyer PN, Kaplitt MJ, editors. Vascular graft. New York: Appleton Century Crofts; 1978. p. 119–29.
28.
Gaylis H. Pathogenesis of anastomotic aneurysms. Surgery. 1981;90(3):509–15.PubMed
29.
Esolowski AS, Golaski WM, Saquwage LR, et al. Considerations in the development of small artery prostheses. Trans Amer Soc Artif Intern Organs. 1968;14:43–7.
30.
Dubost C, Allary M, Olconomos N. Resection of an aneurysm of the abdominal aorta: reestablishment of the continuity by a preserved human arterial graft with result after five months. Arch Surg. 1952;64:405–8.CrossRef
31.
32.
Edwards JM, Teefey SA, Zierler RE, Kohler TR. Intraabdominal paraanastomotic aneurysms after aortic bypass grafting. J Vasc Surg. 1992;15:344–53.PubMedCrossRef
33.
Stoney RJ, Albo EJ. False aneurysms occurring after arterial grafting operations. Am J Surg. 1965;110:153–61.PubMedCrossRef
34.
Dadgar L, Downs AR, Deng X, et al. Longitudinal forces acting at side-to-end and end-to-side anastomoses when a knitted polyester arterial prosthesis is implanted in the dog. J Investig Surg. 1995;8(3):163–78.CrossRef
35.
Read RC, Thompson BW. Uninfected anastomotic false aneurysms following arterial reconstruction with prosthetic grafts. J Cardiovasc Surg (Torino). 1975;16(5):558–61.
36.
Sieswerda C, Skotnicki SH, Barentz JO, Heystraten FMJ. Anastomotic aneurysms – an underdiagnosed complication after aorto-iliac reconstructions. Eur J Vasc Surg. 1989;3:233–8.PubMedCrossRef
37.
38.
Bastounis E, Georgopoulos S, Maltezos C, Balas P. The validity of current vascular imaging methods in the evaluation of aortic anastomotic aneurysms developing after abdominal aortic aneurysm repair. Ann Vasc Surg. 1996;10:537–45.PubMedCrossRef
39.
Madoff DC, Gupta S, Toombs BD. Arterioureteral fistulas: a clinical, diagnostic, and therapeutic dilemma. AJR Am J Roentgenol. 2004;182:1241–50.PubMedCrossRef
40.
Krambeck AE, DiMarco DS, Gettman M, Segura JW. Ureteroiliac artery fistula: diagnosis and treatment algorithm. Urology. 2005;66:990–4.PubMedCrossRef
41.
Fox JA, Krambeck A, McPhail EF, Lightner D. Ureteroarterial fistula treatment with open surgery versus endovascular management: long-term outcomes. J Urol. 2011;185:945–50.PubMedCrossRef
42.
Malgor RD, Oderich GS, Andrews JC. Evolution from open surgical to endovascular treatment of ureteral–iliac artery fistula. J Vasc Surg. 2012;55:1072–80.PubMedPubMedCentralCrossRef
43.
Bergqvist D, Parsson H, Sherif A. Arterio-ureteral fistula – a systematic review. Eur J Vasc Endovasc Surg. 2001;22:191–6.PubMedCrossRef
44.
Ferrante A, Manni R, Giustacchini M, Cotroneo A, Snider F. Arterioureteric fistula: successful treatment of two cases. Eur J Vasc Endovasc Surg. 2004;28:559–61.PubMedCrossRef
45.
Wu IH, Chueh SC, Liang PC. Simultaneous endovascular treatment of a ureteroiliac fistula and common iliac artery occlusion. Eur J Vasc Endovasc Surg. 2008;16:1–3.
46.
Xiangyi Z, Yiwei L, Bin C, Xianyong Z, Xiaofeng Z, Yuehong S, Liping X. Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula. BMC Urol. 2013;13:68.CrossRef
47.
Nobuhiro T, Yusuke N. Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report. BMC Res Notes. 2014;7:19.CrossRef
48.
Takahashi Y, Hirai H, Sasaki Y, Shibata T, Bito Y, Suehiro S. Successful surgical treatment for rupture of an iliac artery aneurysm into a ureter. Ann Vasc Dis. 2009;2:58–61.PubMedPubMedCentralCrossRef
49.
Arap S, Góes GM, de Freire JG, Nardy OW, Azevedo JR. Uretero-arterial fistula [in Portuguese]. Rev Paul Med. 1965;67:352–6.PubMed
50.
Subiela JD, Balla A, Bollo J, Dilme JF, Soto Carricas B, Targarona EM, Rodriguez-Faba O, Breda A, Palou J. Endovascular management of ureteroarterial fistula: single institution experience and systematic literature review. Vasc Endovasc Surg. 2018;52(4):275–86.CrossRef
51.
Pillai AK, Anderson ME, Reddick MA, Sutphin PD, Kalva SP. Ureteroarterial fistula: diagnosis and management. Am J Roentgenol. 2015;204(5):W592–8.CrossRef
52.
Tselikas L, Pellerin O, Di Primio M, Arfi MB, Joskin J, Beyssen B, Thiounn N, Sapoval M. Uretero-iliac fistula: modern treatment via the endovascular route. Diagn Intervent Imaging. 2013;94(3):311–8.CrossRef
53.
Das A, Lewandoski P, Laganosky D, Walton J, Shenot P. Ureteroarterial fistula: a review of the literature. Vascular. 2016;24(2):203–7.PubMedCrossRef
Metadata
Title
Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report
Authors
Luan Jaha
Vlora Ismaili-Jaha
Bekim Ademi
Fahredin Veselaj
Destan Kryeziu
Bujar Gjikolli
Agreta Gecaj-Gashi
Adhurim Koshi
Art Jaha
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Hematuria
Published in
Journal of Medical Case Reports / Issue 1/2019
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-019-2300-8

Other articles of this Issue 1/2019

Journal of Medical Case Reports 1/2019 Go to the issue

Case report

Paraneoplastic pyoderma gangrenosum associated with adenocarcinoma of the rectosigmoid junction: a case report

Case report

Rheumatoid nodules in thyroid gland parenchyma as an expression of rheumatoid arthritis: a case report

Case report

Lumbar vertebral osteomyelitis and psoas abscess caused by Actinomyces israelii after an operation under general anesthesia in a patient with end-stage renal disease: a case report

Case report

Giant mucinous cystadenoma: a case report

Case report

Kikuchi–Fujimoto disease associated with systemic lupus erythematosus complicated with hemophagocytic lymphohistiocytosis: a case report

Case report

Neurosarcoidosis resulting in thoracic radiculopathy: a case report