血管内カバードステント留置により止血し得た尿管総腸骨動脈瘻

Endovascular treatment of ureteroarterial fistula with covered stent：a case report

84歳，男性。直腸癌術後の尿管狭窄に対して両側尿管ステントを留置し，7年間定期的に交換していた。最終交換から10日後に膀胱タンポナーデとなり，当科を受診した。血管造影で明らかな瘻孔は認めなかったが，臨床経過から右尿管総腸骨動脈瘻と判断し，右総腸骨動脈内にカバードステントを留置した。これにより血尿は消失し，10か月経過した現在も再発を認めていない。

An 84-year-old man suffered from bilateral ureteral stricture after the Miles' operation in 1996, had been treated by bilateral double-J ureteral stent for 7 years. Exchange of the stent was performed at every 3 months. 10 days from the last exchange, he was admitted bcause of sudden onset of massive hematuria. Although the fistula was not confirmed by angiography, a right ureteral-common iliac artery fistula was highly suspected. We treated the fistula successfully using endovascular covered stent. During 6 months of follow up, he has been free of hemorrhagic episode.