Thomas Steiner’s research while affiliated with HELIOS Klinikum Erfurt and other places

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Publications (1)

Fig. 4 a CT scan showing the point of vascular crossing over the distal CIA with a ureteral stent seen (arrow). b A negative DSA shortly prior to a planned endovascular aortic repair (EVAR) due to an aortic aneurysm. During this angiography session, a kidney bleeding was also excluded (not seen). c Coiling of the IIA (star) and coverage of the origin of the IIA using the left leg of the SG (arrow) were performed during the EVAR procedure. d Pseudoaneurysm at the distal end of the stent graft denoting the first recurrence after 3 years (arrow). e Distal elongation of the SG using a Viabahn VBX SG with complete closure of the pseudoaneurysm in the immediate control image. f DSA after 24 h due to recurrent macrohematuria showing recurrence of the pseudoaneurysm (arrow). g Post-dilatation of the Viabahn VBX SG using a larger balloon (star) at the site of the visible pseudoaneurysm. h Complete obliteration of the pseudoaneurysm
Fig. 5 a R-UPG showing the flow from the ureter into a vascular structure (arrow). b and c A 2 months old CT scan showing the course of the left ureter (white arrow) crossing the midline between the aorta and the IMA (red arrow) after bilateral ureterocutaneostomy on the right side (star) with bilateral ureteral stents. d Overview DSA with an apparently normal IMA at the uretero-arterial crossing point (red arrow). Notice the lying left ureteral stent in place (star). e A selective DSA of the IMA using a microcatheter with direct visualization of contrast medium flowing into the ureter (white arrow) with a clear UVF at the uretero-arterial crossing point as direct visualization of the UVF (red arrow) after provocation by pulling the stent beyond the crossing point by the urologist (star). f Front door -back door coil embolization of the IMA with the starting point distal to the uretero-arterial crossing point (red arrow). Despite the stent remaining in a retracted position (star), complete elimination of the UVF through the coils was achieved
List of rare and unexpected UVF locations in patients without UD
List of rare and unexpected UVF locations in patients with UD
List of Double vessel UVF

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Anatomic locations of ureterovascular fistulae: a review of 532 patients in the literature and a new series of 8 patients
  • Article
  • Full-text available

August 2024

CVIR Endovascular

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Hendrik Heers

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Thomas Steiner

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Ralf Puls

Introduction Ureterovascular fistula (UVF) is a rare but potentially life-threatening condition. Since its primary description by Moschkowitz in 1908, many case reports, studies and reviews have been written about this condition with the suggestive symptoms and risk factors repeatedly discussed. This study will be focusing on the different locations of 532 out of 605 fistulae published from 1908 up to 2022 besides eight new patients of our own. Material and methods A systematic review of the literature started using PubMed database searching for “ureteroarterial fistula”, “arteriovascular fistula” and “uretero vascular fistula” was performed yielding 122, 62 and 188 results respectively. Those studies and the cited literature in each study were examined to include studies, which did not appear in the primary search. A total of 605 patients in 315 publications were gathered. Only studies mentioning new patients, a clear indication of the location of the UVF, the presence/absence of urinary diversion (UD) as well as the type of UD if present were included. Ten duplicates as well as studies lacking information regarding the UVF and/or the UD (seven publications with 63 patients) were excluded, with 298 publications including 532 external patients remaining. Eight internal cases were included with a total of 540 cases. Results From the 540 included cases, 384 patients (71.1%) had no UD compared to 156 patients (28.9%) with UD. Due to the anatomical ureteral course, the common iliac artery (CIA) was the most common vascular component of UVF, irrespective of the presence or absence of UD. Any dispute to whether the crossing point is the common or the external iliac artery (EIA) was settled for the CIA. Further common vascular components besides CIA include the aorta, EIA, internal iliac artery (IIA) including its branches and vascular bypasses including the anastomosis sites. Other unusual arterial localizations were stated under the “others” category. Conclusion Identifying the location of the bleeding artery in UVF is critical and represents the most important step for successful management. We present the largest summary of described locations up to date including our own. Graphical Abstract

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