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A 77-year-old man with diabetes, dyslipidemia, and a history of smoking
presented with asymptomatic, gross hematuria and left hydronephrosis.
Computed tomography (CT) angiography revealed a left ureteral tumor
(25×18 mm) and an abdominal aortic aneurysm (76×73 mm) (Figure 1).
Cardiac catheterization revealed right coronary artery (RCA) stenosis
(Figure 2). Bone scintigraphy revealed no bone metastasis.
First, a left nephroureterectomy was performed via a midline abdominal
incision. For minimal invasiveness, a median sternotomy was avoided, and
off-pump coronary artery bypass grafting of the RCA was performed with
the great saphenous vein graft, using the left renal artery as the graft
inflow. The arterial grafts (employing the radial artery) were
insufficiently long. Y-grafting was subsequently performed.
Post-surgery, the patient experienced no complications and was
discharged on the 25th postoperative day.
Postoperative CT angiogram confirmed graft patency (Figure 3). The
patient provided informed consent for publishing this case report.
Pathological examination of the removed left kidney and ureter revealed
a non-invasive low-grade papillary urothelial carcinoma. Urothelial
carcinoma reportedly metastasizes through the intravenous route.
Therefore, this method supposedly has no adverse effects on cancerous
metastases. For a transdiaphragmatic approach, a method using the
gastroduodenal artery as the inflow site has been
reported.1,2 This procedure has potential use for
removing ureteral tumors by surgeons and clinicians in clinical
settings.