Endovascular treatment of arterioureteral fistulae involving both external and internal iliac arteries ; Report of a rare case

Arterioureteral fistula (AUF) is a rare condition that may lead to lethal hematuria if not treated promptly. A 65-year-old female presented at our emergency department with massive hematuria and associated hypotension. She had a history of cervical cancer treated with radical hysterectomy followed by adjuvant chemotherapy and radiotherapy. Although computed tomography scan findings and renal angiography showed no signs of active bleeding, the symptom of hematuria aggravated. Even after prophylactic embolization of both renal arteries, hematuria persisted. On cystoscopy, there was a jet flow of bleeding from the right orifice of the ureter. AUF was highly suspected and subsequent intra-operative angiography was performed. Fistulous connections were observed and managed with endovascular repair. We report a rare case of AUFs showing connections with both the right external and internal iliac arteries.