In Reply to: Case 1097_10 --Treatment of external iliac artery pseudoaneurysm with a fistula to the bladder posted by Editor on October 14, 1997 at 15:39:54:
Nice looking result. I do have a question about whether you gave antibiotics prior to stent-graft placement. My concern (above and beyond the general one regarding antibiotic prophylaxis for any stent or stent-graft) is that the direct communication with the bladder may predispose the graft to becoming infected.
By the way, this is a variant of a problem (iliac artery-ureteral fistula) which has been discussed nicely in the IR literature by the group at Mallinckrodt:
Kerns DB, Darcy MD, Baumann DS, Allen BT. Autologous vein graft stent for the endovascular management of an iliac artery-ureteral fistula: case report and review of the literature. J Vasc Surg 24:680-686, 1996
Quillin SP, Darcy MD, Picue D. Angiographic evaluation and therapy of ureteroarterial fistulas. AJR 162:873-878, 1994.
The other potential means of treatment, if the patient could tolerate it, would be embolization of the external iliac artery followed by extraanatomic bypass grafting (e.g. fem-fem bypass).