Table 1.
Clinical history of our patients
| Case 1 | Case 2 | ||
|---|---|---|---|
| 1st episode | 1st episode | 2nd episode | |
| Gender | Male | Female | |
| Age at UAF onset | 72 | 56 | 64 |
| Smoking | Yes | No | No |
| Comorbidities and history | Aorto-iliac atherosclerosis | Comorbidities: AH, CKD, chronic anaemia. History: vasculitis, left iliac-femoral DVT. | |
| Charlson comorbidity index (CCI) | 9 | 4 | 5 |
| Previous surgery (abdominal, retroperitoneal) | None | Left nephrectomy (February 2014) for chronic erosive pyelitis | |
| Previous Surgery (oncological) | RARC with lymphadenectomy | Hystero-adnexectomy + lymphadenectomy | |
| Urinary diversion | Ileal orthotopic neobladder | none | |
| Chemotherapy (CHT) – immunotherapy (IO) | Adjuvant CHT + IO | Adjuvant CHT | |
| Radiotherapy | No | Yes (pelvic) | |
| Periodical stent substitution | Yes (right) | Yes, bilateral (after RN, only right ureteral substitutions) | Yes (right ureter) |
| Stenting placement: indication | Hydronephrosis (right ureter-neobladder anastomosis stenosis) and right pyelonephritis | Hydronephrosis (ureteral stenosis) | |
| Side/level fistula | Right proximal EIA | Left CIA (residual ureter) | Right proximal IIA |
| Indwelling stent at UAF diagnosis | Yes | No | Yes |
| First CT scan | Positive | Negative | Not performed |
| Open surgery | No | No | No |
| Endovascular approach | Yes | Yes | Yes |
| Angiography/aortography | Positive | Positive | 1st negative → 2nd positive |
| Pyelography | Positive | Positive | Not performed |
| Ureteropyeloscopy | Not performed | Performed – not diagnostic for massive bleeding | Performed – not diagnostic for massive bleeding |
| UAF onset after first stenting | 16 months (February 2020) | 7 years (May 2014) | 13 years (July 2019) |
| Arterial embolization | Right hypogastric artery | Left hypogastric artery | Right hypogastric artery |
| Materials and type of arterial by-pass | Viabahn® 5 mm × 100 mm between right common iliac artery and External iliac artery | Viabahn® 9 mm × 100 mm in left Common iliac artery | Viabahn® 16 mm × 12 mm × 100 mm between right proximal common iliac artery and External iliac artery |
| Ureteral embolization | No | Yes | No |
| UAF onset after RT (months) | / | Unknown | Unknown |
| Stent material and Ch | Polyurethane hydrophilic-coated double J 8 Ch | nd | Allium®, Silicone hydrophilic-coated (Vortek®) double J 7 Ch |
| Rebleeding | No | No | Yes |
| Indwelling ureteral stent/nephrostomy post UAF | Nephrostomy | Right ureteral stent | Right ureteral stent |
| Therapy at discharge | Acetilsalicilic acid 100 mg | LMWH and antibiotics | LMWH and antibiotics |
| Follow-up (complications) | No | No | Rebleeding; right uretero-colic fistula |
| Follow-up (further surgery/endovascular surgery) | No | No | Endovascular prothesis placement; haemicolectomy and colostomy |
| Death | 3 months earlier for BC metastatic progression | No | No |
AH: arterial hypertension; CDK: chronic kidney failure; DVT: deep venous thrombosis; RARC: robot-assisted radical cystectomy; EIA: external iliac artery; CIA: common iliac artery; IIA: internal iliac artery; LMWH: low molecular weight heparin; BC: bladder cancer.