IP133. Successful Repair of an Arteriovesical Fistula as a Complication After Coil Embolization for Right Hypogastric Artery Aneurysm

We describe a complicated repair of an arteriovesical fistula from a percutaneous arterial embolization for a right hypogastric artery aneurysm. This is a case report of one patient. An 84-year-old man presented to the outpatient clinic for gross hematuria. He was several years status post excluding stent graft coverage and incomplete outflow coil embolization of a right internal iliac artery aneurysm. The aneurysm continued to enlarge because of a type II endoleak and multiple percutaneous translumbar coil embolizations. Four years after the last embolization intervention, he was seen by the urology service for hematuria, and cystoscopy showed several vascular embolization coils extruding into his bladder. Computed tomography angiography and transfemoral catheter angiography confirmed resolution of the endoleak and revealed a large right internal iliac artery aneurysm, defined by the coils that extended toward midline. There were no overt signs of sepsis. Given the extent of the bladder injury, persistent hematuria, and exposure of the previous endograft to the genitourinary contents, he underwent a joint open repair of the bladder with the urology service. We revascularized with a left-to-right femoral-femoral bypass graft through clean incisions. Through a midline laparotomy, we removed in entirety the iliac endograft and all the coils. The right external and common iliac arteries were isolated and oversewn. The bladder was repaired primarily. Although no pus was encountered, the coils were found extruding out the aneurysm into the retroperitoneum. Graft cultures grew Staphylococcus epidermidis. The patient received long-term antibiotic treatment. On follow-up, he is doing well and has had complete healing of the bladder. Arteriovesical fistula is a rare disease and should be suspected in patients with hypogastric artery aneurysm and hematuria.