PMC7534066_01
(a) CT angiography (coronal plane). (b) CT scan showing that the right ureter (red arrow) coursed above the right EIA (red arrowhead) and was in contact with the EIA. (c) Aortogram showing no contrast leak in the right ureter. The crossing point (red oval) of the right ureteral stent (white arrow) and the right EIA (white arrowhead) indicates the presence of an AUF. (d) The right IIA is embolized using a 10 x 7 mm vascular plug (white arrowhead) to prevent endoleak. (e) The 7 x 79 mm GORE  VIABAHN  VBX Stent Graft (white arrowhead) inserted with nominal pressure with its proximal apposition site within the CIA and the distal apposition site within the EIA. (f) Post-dilatation performed at the CIA with a 10 x 20 mm balloon catheter (white arrowhead). (g) Post-dilatation performed at the EIA with an 8 x 40 mm balloon catheter (white arrow). (h) No contrast leakage. Moreover, the IIA is well embolized, and the VBX is well dilated.. CT = computed tomography, EIA = external iliac artery, AUF = arterio-ureteral fistula, IIA = internal iliac artery, CIA = common iliac artery.
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Cystoscopy did not reveal any abnormal findings of bleeding in the bladder, and computed tomography (CT) showed that the right ureter coursed above and seemed to be connected to the right external iliac artery (EIA); thus, the presence of AUFs between the right EIA and the right ureter was suspected (Figure 1(a) and (b)). Aortography (AOG) was performed via a 4-French pigtail catheter (Figure 1(c)). The guidewire was withdrawn, and a 10 x 7 mm vascular plug was deployed using the sheathless guiding catheter, following embolization of the right IIA to prevent type II endoleak (Figure 1(d)). The VBX Stent Graft was inserted with nominal pressure covering the CIA and the EIA, crossing over IIA (Figure 1(e)). The VBX at the CIA was post-dilated with a 10 x 20 mm balloon catheter (Figure 1(f)), and the VBX at EIA was dilated with an 8.0 x 40 mm balloon catheter (Figure 1(g)). The IIA was well embolized, and the VBX was well expanded (Figure 1(h)).