Ureteroarterial XXXX treatment with open surgery versus endovascular management: long-term outcomes.

@entity1 @entity548 @entity63 @entity292 @entity432
PURPOSE: Ureteroarterial @entity292 can be treated with open vascular or percutaneous arterial stent placement. We compared the long-term outcomes of each treatment. MATERIALS AND METHODS: A single center, retrospective review of @entity292 (1996 to 2008) was performed. RESULTS: We identified 20 @entity292 in 19 @entity1 . All @entity1 had undergone extirpative surgery with pelvic radiation in 74% and long-term ureteral stents in 84%. At a mean followup of 15.5 months (range 1 to 99) survival was 53%. Of the 70% (14 of 20) treated with percutaneous @entity432 stenting or embolization, 2 @entity1 later required open vascular graft and 12 were treated with long-term ureteral stenting. Of the 30% (6 of 20) of @entity1 treated with open surgical repair or bypass 2 required bypass revision and/or thrombectomy, and 4 had concomitant ureteral ligation or nephrectomy. Despite undergoing anticoagulation 10 @entity1 (53%) experienced lower extremity morbidity including ulceration, @entity63 and amputation. In each treatment group 2 @entity1 had recurrent @entity548 requiring a secondary procedure, leading to death in 2 for an overall 10% acute mortality rate. Overall noncause specific mortality of @entity292 was 47% and 10% to 20% was related to the @entity292 or treatment complications. CONCLUSIONS: Endovascular stenting is increasingly used in lieu of open techniques due to the high operative risk and comorbidities in @entity1 with @entity292 . This retrospective review fails to identify a clear advantage for endovascular or open vascular surgical management. Thus, endovascular stenting is preferred in most cases. Regardless of therapy, @entity1 are at risk for recurrent @entity548 , lower extremity complications and stent/graft complications. The use of antibiotics and long-term anticoagulant therapy appear prudent but not proved.
