PMC8371582_01
Left nephrostogram with contrast noted extravasating through the fistula tract from the left ureter into the left iliac artery.
CRIU2021-8165991.001.jpg
PMC8371582_01_CRIU2021-8165991.001.jpg
fig1
Antegrade nephrostogram was performed, and a large fistula between the left ureter and the left common iliac artery was noted (Figure 1).
Arteriogram following endograft placement with no contrast exiting the arterial system. Left nephroureteral stent is noted traversing the location of graft placement highlighting the region of fistula formation.
CRIU2021-8165991.002.jpg
PMC8371582_01_CRIU2021-8165991.002.jpg
fig2
An 8 mm x 39 mm VBX covered stent was advanced and deployed in the midcommon iliac artery, with a follow-up angiogram showing no evidence of pseudoaneurysm, active bleeding, or fistula (Figure 2).
PMC8371582_02
Left ureter raised with left bipolar forceps and small Hem-o-lok clip controlling the divided smaller vascular connection with a laparoscopic Satinsky clamp placed on the left external iliac artery proximal to the ureteroiliac fistula.
CRIU2021-8165991.003.jpg
PMC8371582_02_CRIU2021-8165991.003.jpg
fig3
A small vessel directly communicating with the ureter and the left external iliac artery was identified and clipped with a Hem-o-lok and divided with good hemostasis (Figure 3).