Successful Endovascular Management of an Arterioureteral Fistula Presenting with Massive Hematuria in a Failed Renal Transplant.

Background: Renal transplantation is a common surgical intervention for end-stage renal failure. Arterioureteral fistula (AUF) is a rare but important cause of gross hematuria that can be difficult to diagnose and associated with high morbidity and mortality. Case Presentation: We report a case of a 68-year-old woman presenting with acute or chronic hematuria on a background of two renal transplants. Her initial renal transplant failed 8 years after the initial surgery but was left in situ. Her hematuria was initially investigated with cystoscopy; however, this did not identify a bleeding point and during which the patient became hemodynamically unstable. After transfer to the interventional radiology suite, the patient underwent fluoroscopic angiography. This did not immediately demonstrate a bleeding point. However, a CT angiogram was subsequently undertaken that identified an AUF between the native left ureter and the failed transplant renal artery. This was effectively managed with placement of a covered endovascular stent.
Conclusion: Owing to efficacy and safety, endovascular management is an attractive option for treatment of AUF. Furthermore, endovascular treatment may provide a transplant sparing option, in those with functioning organs. Copyright 2020, Mary Ann Liebert, Inc., publishers.