PMC4857363_01
(a) Aortogram shows extravasation from the left external iliac artery and (b) delayed images during the angiogram show pooling of contrast in the pelvis centrally.
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A pelvic aortogram showed active extravasation of contrast from the left external iliac artery into the pelvis, in proximity to the course of the left ureter (Figure 1(a)). Contrast material appeared to pool centrally in the pelvis toward the vagina (Figure 1(b)).
(a) Fluoroscopic spot image during placement of a 7 mm x 30 mm Wallgraft covered stent (arrow) and (b) aortogram after covered stent placement in the left external iliac artery demonstrates no extravasation.
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A 7 mm x 30 mm covered stent (Wallgraft Endoprosthesis; Boston Scientific, Natick, MA, USA) was then placed across the area of extravasation from the left external iliac artery (Figure 2(a)). A repeat angiogram demonstrated no further extravasation of contrast from the previous site of hemorrhage (Figure 2(b)).
PMC4857363_02
(a) Fluoroscopic spot image from a right renal arteriogram shows no evidence of vascular injury, (b) fluoroscopic spot image during injection of the right common iliac artery shows contrast entering into the ureter, (c) contrast noted refluxing up into a dilated proximal ureter after injection of the right common iliac artery, and (d) aortogram after placement of a covered stent in the right common iliac artery demonstrates exclusion of the arterio-ureteral fistula.
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Vascular injury during her nephrostomy placement was suspected, and a renal arteriogram was performed (Figure 3(a)). After the embolization, the catheter was withdrawn to the right common iliac artery and an angiogram was performed which outlined the ureter (Figure 3(b)), with contrast reflux noted up the dilated right ureter to the level of the kidney (Figure 3(c)). A 10 mm x 50 mm covered stent (Wallgraft Endoprosthesis; Boston Scientific) was then placed across the fistula. Aortogram after placement of the covered stent showed exclusion of the AUF (Figure 3(d)).