Successful endovascular treatment of massive hematuria due to ureteroarterial fistula secondary to ureterocutaneostomy

Ureteroarterial fistula (UAF) is an uncommon condition due to a fistulous communication between a ureter and aorta or iliac artery. It is not only challenging to identify, but also potentially lethal, and it can be associated with pelvic irradiation, malignant disease and previous pelvic-abdominal surgery. UAF can be classified into primary and secondary ones: primary fistula is related to aorto-iliac aneurysms while secondary ones occur after pelvic surgery, pelvic radiation or ureteral stenting, and the most common risk factor is the presence of a chronic indwelling ureteral stent. Surgery represents the traditional therapeutic approach but, in the last years, endovascular approach has become a safe and effective minimally invasive alternative, especially in patients with many comorbidities and complicated anatomic presentation. In this manuscript, we reported the case of a 76-year-old man, with bilateral ureterocutaneostomy after previous radical cystectomy, who presented to our emergency department for gross pulsatile hematuria from the left ureterocutaneostomy, due to a UAF with the left external iliac artery, solved by endovascular placement of a covered stent graft.