Endovascular management of arterio-ureteral fistula in a patient with a challenging hematuria

Arterio-ureteral fistula (AUF) is a rare, but life-threatening disease that causes massive hematuria. We present a case of a 43-year-old female with AUF successfully treated with coil embolization and deployment of endovascular stents, along with a literature review. AUF symptoms most commonly occur with intermittent hematuria. AUF can occur in association with ureteral stenting, radiation, and prior pelvic or vascular surgery. Arteriography or ureteral pyelography are recommended as the most effective diagnostic strategies. Recent treatment efforts have focused on the use of endovascular stenting techniques as an alternative to open surgery.