Uretero-Arterio-Enteric Fistula Formation and Stent Thrombosis After Endovascular Treatment of Ureteroarterial Fistula: A Case Report and Review of Literature

Background: Ureteroarterial fistulas (UAFs) are rare life-threatening complications of indwelling ureteral stents. Endovascular repair of these fistulas is now commonly used but the long-term outcomes are unknown. Case Presentation: We present a 51-year-old African American female with history of cervical cancer status after a hysterectomy and radiation. She has bilateral ureteral strictures that were managed with chronic, indwelling ureteral stents. She subsequently developed a right UAF and was treated with an endovascular stent to the external iliac artery. After 2 years, she subsequently developed hematuria and hematochezia and was found to have a uretero-arterial-enteric fistula. We performed an exploratory laparotomy and repair of the fistula. The patient was subsequently managed with indwelling nephrostomy tubes and had no further episodes of bleeding. Conclusion: To our knowledge, this is the first reported case of uretero-arterial-enteric fistula after endovascular treatment of UAF. Our experience demonstrates the need for a high index of suspicion and close surveillance after treatment for patients with UAF.