A primary arterial–ureteral fistula after an aortic-bifemoral bypass

AbstractINTRODUCTIONPrimary arterial–ureteral fistula is a rare and diagnostically challenging condition which may present with massive hematuria.PRESENTATION OF CASEA case of primary arterial–ureteral fistula (AUF) is presented in a patient with a previous prosthetic aortic-bifemoral bypass. The AUF treated with arterial and ureteral resection, arterial ligation and ureteral reconstruction.DISCUSSIONPrimary AUF are more frequently associated with aneurysmal degeneration of the arterial wall. The development of a primary fistula due to an iliac artery aneurysm many years after an aortic-bifemoral bypass performed due to atherosclerotic obstructive disease is a very unusual presentation of this entity. Multiple surgical strategies can be employed in achieving hemorrhage and infection control, urinary tract continuity, and vascular reconstruction.CONCLUSIONA multidisciplinary approach and the achievement of a pre-operative diagnosis are essential for an effective management of this condition with prognostic implications