PMC

Final fluoroscopic image demonstrates effective bilateral ureteral occlusion using the “sandwich” method. Vascular plugs (white arrows), opaque NBCA glue (black arrows), and bilateral nephrostomy tubes (asterisks).

A and B:Contrast-enhanced coronal computed tomography showing intense bilateral hydronephrosis (red arrow) and occlusion of the distal ureter (yellow arrow) by the pelvic mass (red star) invading both ureteral orifices, rendering cystoscopic double J stenting impossible. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Bilateral antegrade trans- nephrostomic pyelography showing two AMPLATZER Vascular Plug II (arrows) filled with NBCA and placed proximal to ureterosigmoidostomies

A 76-year-old woman with history of rectal carcinoma underwent limited anterior resection and neoadjuvant chemoradiation therapy. Following chemoradiation and anterior resection, the patient developed bilateral hydronephrosis that was managed with bilateral ureteral stents. Six weeks after the stent placement, the patient presented with hematuria. (a) Contrast-enhanced CT scan demonstrates a pseudoaneurysm arising from the left external iliac artery (arrow), presumed to be due to erosion of the left distal ureter and external iliac artery by the ureteral stent. (b) Digital subtraction angiography of the left common iliac artery performed via a right common femoral artery approach confirms the above-described pseudoaneurysm (arrow) arising from the left external iliac artery. (c) Digital subtraction angiogram of the left common iliac artery following placement of an 8 mm × 50 mm Viabahn covered stent (Gore Inc., Flagstaff, AZ) across the above-described pseudoaneurysm demonstrating complete occlusion of the pseudoaneurysm. Clinically, following left common iliac artery endograft placement, there was complete cessation of hematuria.