Endovascular treatment for ureterorectal-arterial fistula and external iliac artery stenosis caused by recurrent endometrial cancer invasion: A case report

TL;DR

A 48-year-old woman with recurrent endometrial cancer was successfully treated for a rare arterial fistula and artery blockage using minimally invasive endovascular techniques.

Contribution

This case report presents a novel endovascular approach to manage surgically untreatable complications of recurrent endometrial cancer.

Findings

Arterial embolization effectively controlled catastrophic bleeding from a ureterorectal-arterial fistula.

Stent graft implantation resolved external iliac artery stenosis in the same patient.

Endovascular treatment is a viable alternative for managing complex vascular complications in cancer patients.

Abstract

Owing to improvements in anticancer treatment, patients’ overall survival has been prolonged, and late complications occur more frequently than previously. We successfully managed a case of ureterorectal-arterial fistula (URAF) and external iliac artery (EIA) stenosis due to endometrial cancer recurrence using an endovascular approach, including arterial embolization and angioplasty. The patient was a 48-year-old woman undergoing chemoradiotherapy for recurrent endometrial cancer following surgery and adjuvant chemotherapy. Tumor involvement and its response to treatment led to the development of URAF and EIA stenosis. Catastrophic bleeding occurred from URAF, and hemostasis was successfully achieved by left internal iliac artery embolization using a mixture of N-butyl cyanoacrylate and ethiodized oil. Nine days after embolization, angioplasty was performed using a stent graft implantation for EIA stenosis. Endovascular treatment is considered a crucial approach for managing both URAF and arterial stenosis, which is surgically untreatable.

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