\ ""I. 11 -l. Octobe r l'rlnted In I 1.S.A
THF. ,JOLRNAI. OF lJROLO extrinsic compression of the
651
PEI.\ I(' AHTEHIO\ E;sOL s FISTl LAS
F1G. -1. Postoperative urteriogram. Selecti,·e iniel'tion of lc>ft internal iliac art er,· shows ligated ,·essel and no evidence of remaining fistula. Previoush· not ed bladder deform ii\· has partial! _,· reso h- ed.
lateral bladder wall on !VP should suggest the presence of a pelvic arteriovenous ma! format ion. Angiography is required to demonst rate the feeding vessels before surgical therapv. Because congenital art eriovenous fistulas are formed b\· m ult it udinous communications of the involved ,·essels. resection of the mass is more difficult than for acquired fistulas . The massive blood loss encountered during operation in our case and in cases reported by others 2 indicates that resect ion should be performed only in an institution with facilities for massive blood replacement. Ligation of the feeding vessels demonstrated by angiography is the first step in the operation. It is i m perat i \·e that the ureter be identified early in the operation to prevent injury during dissection. Uretera l catheterization has been used previousl\ 6 and would be helpful in cases such as ours in which the tumor is adherent to the ureter. Resection of as much of the fistula as possible is mandatory to prevent the development of collaterals which could resupphthe tumor. Postoperative angiographv is necessa ry to verifr that all feeding vessels have been ligatPd and that no abnormal vasculature remains C'arPful long-term followup is required for earlv detec tion of recurrence.
KEFEKE NC ES
I. Gomes. M
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M. and He rnat z. P. E.: Arteriovenous fistula s: a re,· iew and ten -,·ea r experie11I. . 16: '.!(J:!. 1%:,. 12. Morie_,·. G. \V . and Lind enauer. S : M. : ,\ rt eriovenous fi stul a followin g pelvic ope ra tio ns. Obst . G~: nec .. :11: 7'.!.'.!.. lf)(j8. 1:1 . Ibach. ,J . IL Hess. I' ..J.. Clo re. F. a nd \\" lwa t. M. W .: Art erim·enous fistula of th e pe h ·is 1'1> IJ ,,win g h_,·s t e reetomv . Case re port of a s irnplifiud surgical treatme nt. .). F lorida M ed. Ass .. 5!l: :!I. ID7'.!. .
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THF. ,JOLRNAI. OF lJROLO extrinsic compression of the
651
PEI.\ I(' AHTEHIO\ E;sOL s FISTl LAS
F1G. -1. Postoperative urteriogram. Selecti,·e iniel'tion of lc>ft internal iliac art er,· shows ligated ,·essel and no evidence of remaining fistula. Previoush· not ed bladder deform ii\· has partial! _,· reso h- ed.
lateral bladder wall on !VP should suggest the presence of a pelvic arteriovenous ma! format ion. Angiography is required to demonst rate the feeding vessels before surgical therapv. Because congenital art eriovenous fistulas are formed b\· m ult it udinous communications of the involved ,·essels. resection of the mass is more difficult than for acquired fistulas . The massive blood loss encountered during operation in our case and in cases reported by others 2 indicates that resect ion should be performed only in an institution with facilities for massive blood replacement. Ligation of the feeding vessels demonstrated by angiography is the first step in the operation. It is i m perat i \·e that the ureter be identified early in the operation to prevent injury during dissection. Uretera l catheterization has been used previousl\ 6 and would be helpful in cases such as ours in which the tumor is adherent to the ureter. Resection of as much of the fistula as possible is mandatory to prevent the development of collaterals which could resupphthe tumor. Postoperative angiographv is necessa ry to verifr that all feeding vessels have been ligatPd and that no abnormal vasculature remains C'arPful long-term followup is required for earlv detec tion of recurrence.
KEFEKE NC ES
I. Gomes. M
:2.
:L -1.
5.
6.
,.
H.
\l.
M. and He rnat z. P. E.: Arteriovenous fistula s: a re,· iew and ten -,·ea r experie11I. . 16: '.!(J:!. 1%:,. 12. Morie_,·. G. \V . and Lind enauer. S : M. : ,\ rt eriovenous fi stul a followin g pelvic ope ra tio ns. Obst . G~: nec .. :11: 7'.!.'.!.. lf)(j8. 1:1 . Ibach. ,J . IL Hess. I' ..J.. Clo re. F. a nd \\" lwa t. M. W .: Art erim·enous fistula of th e pe h ·is 1'1> IJ ,,win g h_,·s t e reetomv . Case re port of a s irnplifiud surgical treatme nt. .). F lorida M ed. Ass .. 5!l: :!I. ID7'.!. .
t:
