Urological complication following aortoiliac graft
case report and review of the literature
Keywords:
Ureter, Ureteral obstruction, Kidney, Hydronephrosis, Blood vessel prosthesisAbstract
CONTEXT: Ureteral stenosis and ureterohydronephrosis may be serious complications of aortoiliac or aortofemoral reconstructive surgery. CASE REPORT: A 62-year-old female patient presented with a six-month history of left lumbar pain. She was a smoker, and had mild chronic arterial hypertension and Takayasu arteritis. She had previously undergone three vascular interventions. In two procedures, Dacron prostheses were necessary. Excretory urography showed moderate left ureterohydronephrosis and revealed a filling defect in the ureter close to where the iliac vessels cross. This finding was compatible with ureteral stenosis, and the aortoiliac graft may have been the reason for this inflammatory process. The patient underwent laparotomy, which showed that there was a relationship between the ureteral stenosis and the vascular prosthesis. Segmental ureterectomy and end-to-end ureteroplasty with the ureter crossing over the prosthesis anteriorly were performed. There were no complications. The early and late postoperative periods were uneventful. The patient evolved well and the results from a new excretory urogram were normal. We concluded that symptomatic ureterohydronephrosis following aortoiliac graft is a real complication and needs to be quickly diagnosed and treated by urologists.
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References
Wright DJ, Ernst CB, Evans JR, et al. Ureteral complications and aortoiliac reconstruction. J Vasc Surg. 1990;11(1):29-35; discussion 35-7.
Jacobson ME, Masto GJ, Berkas EM. Aortic grafts. Ureteral obstruction as a late complication of abdominal aneurysm resection. J Kans Med Soc. 1962;63:516-8.
Pavlica P, Viglietta G, Barozzi L, Piraccini A, Stasi G. Ostruzione ureterale secondaria ad in- terventi di by-pass aorto-femorale [Ureteral obstruction secondary to aortofemoral bypass]. Radiol Med. 1988;75(6):643-6.
Gil-Salom M, Martinez-León J, Maldonado L, et al. Obstructive uropathy following aortofemo- ral graft surgery. Urol Int. 1991;46(1):39-42.
Frusha JD, Porter JA, Batson RC. Hydronephrosis following aorto-femoral bypass grafts. J Cardiovasc Surg (Torino). 1982;23(5):371-7.
Heard G, Hinde G. Hydronephrosis complicating aortic reconstruction. Br J Surg.. 1975;62(5):344-7.
Schubart P, Fortner G, Cummings D, et al. The significance of hydronephrosis after aortofe- moral reconstruction. Arch Surg. 1985;120(3):377-81.
Goldenberg SL, Gordon PB, Cooperberg PL, McLoughlin MG. Early hydronephrosis following aortic bifurcation graft surgery: a prospective study. J Urol. 1988;140(6):1367-9.
Daune B, Batt M, Hassen-Khodja R, et al. Hydronephrosis after aortofemoral bypass graft. A prospective study. J Cardiovasc Surg (Torino). 1991;32(4):447-50.
Henriksen LO, Mejdahl S, Petersen F, Tøonnesen KH, Holstein PE. The incidence of ureteral obstruction secondary to aorto-femoral bypass surgery. A prospective study. Eur J Vasc Surg. 1988;2(6):417-8.
Sant GR, Heaney JA, Parkhurst EC, Blaivas JG. Obstructive uropathy--a potentially serious complication of reconstructive vascular surgery. J Urol. 1983;129(1):16-22.
Schapira HE, Li R, Gribetz M, Wulfsohn MA, Brendler H. Ureteral injuries during vascular surgery. J Urol. 1981;125(3):293-7.
