Ureteral leak around an aortic bifurcation graft: complication of ureteral stenting.

Aortoiliac bypass surgery has a 2 to 20 per cent incidence of ureteral injury causing postoperative hydronephrosis frequently without symptoms. We describe a patient in whom a ureteral stricture developed 12 days after placement of an aortic bifurcation graft. Treatment consisted of ureteral dilation and stenting following which a ureteral leak developed around the bifurcation graft from the stented dilation site, presumably from pressure necrosis of the ureter caught between the pulsating graft and the ureteral stent. The patient did well with external nephrostomy drainage. We conclude that ureteral stenting of patients suffering from significant aortoiliac disease should be approached with great caution, using the softest stent material available