The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function (original) (raw)
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Vascular and Endovascular Surgery, 2020
Introduction: Erectile dysfunction (ED) affects more than 150 million men worldwide, with deleterious effects on quality of life. ED is known to be associated with ischemic heart disease but the impact of ED in patients with peripheral arterial disease (PAD) is unknown. We assessed the prevalence and severity of ED in patients with PVD. Methods: Following ethical approval, sequential male patients diagnosed with PAD over a 1-year period following diagnosis of intermittent claudication. The patient demographics and comorbidities were recorded, with the International Index of Erectile Function (IIEF-5) questionnaire used to grade severity of ED. Computed tomographic angiography and severity of stenosis in the proximal vessels and internal pudendal arteries were correlated using a modified Bollinger Matrix scoring system. Results: 60 patients were recruited, most (77.2%) reported erectile dysfunction (52.5% severe, 22.5% moderate). Patients with severe ED were more likely to have 2 or ...
Impotence in vascular disease: Relationship to vascular surgery
British Journal of Surgery, 1982
This review considers diagnosis and treatment of vasculogenic impotence. It describes current information related to normal mechanisms of penile erection and pathophysiology of organic impotence, methods of preoperative diagnosis, quantitative evaluation of penile bloodflow and operative techniques to be employed in aneurysmal or occlusive aorto-iliac disease. The importance of preserving internal iliac pow and neural fibres enervating the genitalia is stressed. Large vessel reconstructions have proved practical in maintaining or restoring normal erectile function, but at present reconstructions of isolated pudendal or penile artery occlusions are experimental. Medical therapy can be effective in certain marginal cases of small vessel occlusion.
Asian Journal of Andrology, 2015
This case example refers to a patient who developed ED after the diagnosis of CAD has been made representing the classic "exception to the rule" of the ASH. We discuss the potential pathophysiologic background that may explain what we may call the "CAD-ED-CAD sequence" and how it may still fit the ASH. CASE EXAMPLE A 54-year-old man was admitted to the emergency room of our hospital because of chest pain lasting more than 12 h. His cardiovascular history was unremarkable, except for borderline hypertension and hypercholesterolemia (both untreated) and sedentary lifestyle. The electrocardiogram on admission showed anterior myocardial infarction (AMI). Coronary angiography was immediately performed, and an occluded proximal left anterior descending artery was detected (single-vessel disease). Primary percutaneous coronary intervention (PCI) (two drug-eluting-stents [DESs] implanted) was performed with good vessel recanalization (Figure 1a). The post-PCI period was uneventful. A moderate left ventricular dysfunction (ejection fraction [EF] 45%, normal value >55%) was detected by echocardiogram. The patient was discharged on the 6 th day on double antiplatelet treatment (aspirin 100 mg per day + clopidogrel 75 mg per day), beta-blocker (atenolol 50 mg per day), angiotensin-converting enzyme inhibitor (ramipril 5 mg per day) and statin (atorvastatin 40 mg) (all type I, a medication according to European Society of Cardiology guidelines). A questionnaire for ED (International Index of Erectile Function 5 [IIEF-5]) was given to the patient in the 3 rd post-PCI day and found to be normal (score: 23, normal value ≥23).
Vascular interventions for impotence: Lessons learned
Journal of Vascular Surgery, 1995
with the chief complaint of impotence (average age 54.5 years) were screened by use of penile plethysmography and penile brachial indexes: 635 were considered to have normal flow, and 459 were considered to have abnormal arterial flow, 12.2% of whom were found to have aortoiliac disease. Based on negative neural screening results, absence of erectile responses on increasing doses of intracavernously injected papaverine or prostaglandin E 1 (ICI), surgical candidates for microvascular procedures were referred for dynamic infusion cavernosography (DICC) and pudendal arteriography. Operations for men discovered to have aortoiliac disease were based on conventional indications including aneurysm size or limb ischemia. None of the subjects had diabetes. Only those patients without diabetes and those not requiring blood pressure medications were selected for microvascular procedures. We report our experience and surgical outcomes at average follow-ups of 33 to 48 months. Four types of operations were performed on 67 men (age 18 to 79 years). These included 17 aortoiliac reconstructions, 11 dorsal penile artery bypasses, 12 dorsal vein arterializations, and 27 venous interruptions. Follow-up data were obtained by direct examination and noninvasive Doppler examinations; repeat arteriography (4 of 11); repeat DICC after venous ablation procedures (18 of 27) and postoperative ICI response. Mail questionnaires completed postoperative surveillance. Results: Among 17 men undergoing aortoiliac intervention for aneurysms in eight and occlusive disease in nine, 58% functioned spontaneously after operation and 18% used ICI or vacuum constrictor devices at an average follow-up time of 38 months. Among 11 men with dorsal penile artery bypasses, 27% fimctioned spontaneously and 45% used ICI at an average follow-up time of 34.5 months. Among 12 men with dorsal vein arterialization, 33% fianctioned spontaneously, and 47% used ICI at an average follow-up time of 48 months. Among 27 with venous interruption, 33% functioned spontaneously and 44% used ICI. In seven of eight aneurysms of 4.5 to 6.0 cm in size, impotence workup led to discovery; probable embolic mechanisms existed in three. Venous interruption efficacy correlated with postoperative DICC results when flow to maintain erection was 40 ml or less. Apart from two cases of glans hyperemia, no surgical complications occurred in the microvascular procedures. There was one episode of bleeding caused by DICC after aortic reconstruction. There were no deaths. Conclusions: With prospective screening criteria, 6% to 7% of impotent men became candidates for vascular intervention. Including those functioning with ICI or vacuum constriction devices, about 70% of these men were fimctional after operation. Men undergoing aortoiliac reconstruction has a significantly higher rate (58%) of spontaneous function as compared with those undergoing microvascular procedures.
Evaluation of function of vascular endothelium at patients with erectile dysfunctions
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The Role of Interventional Radiology in the Diagnosis and Management of Male Impotence
CardioVascular and Interventional Radiology, 2012
Erectile dysfunction (ED) is defined as the persistent inability to reach or maintain penile rigidity enough for sexual satisfaction. Nearly 30% of the men between ages 40 and 70 years are affected by ED. A variety of pathologies, including neurological, psychological, or endocrine disorders and drug side effects, may incite ED. A commonly identified cause of ED is vascular disease. Initial diagnostic workup includes a detailed physical examination and laboratory tests. Whilst duplex ultrasound is considered the first-line diagnostic modality, intra-arterial digital subtraction angiography is still considered the ''gold standard'' for the diagnosis of arteriogenic impotence. Percutaneous endovascular treatment may be offered in patients with vasculogenic ED that has failed to respond to oral medical therapy as an alternative to penile prosthesis or open surgical repair. In arteriogenic ED balloon angioplasty of the aorto-iliac axis, and in venoocclusive ED, percutaneous venous ablation using various embolization materials has been reported to be safe and to improve sexual performance. Recently, the ZEN study investigated the safety and feasibility of drug-eluting stents for the treatment of arteriogenic ED attributed to internal pudendal artery stenosis with promising preliminary results. This manuscript highlights the role of interventional radiology in the diagnosis and minimally invasive treatment of male impotence.
Penile vascular surgery for treating erectile dysfunction (ED) is still regarded cautiously. Thus we reviewed relevant publications from the last decade, summarising evidence-based reports consistent with the pessimistic consensus and, by contrast, the optimistically viable options for vascular reconstruction for ED published after 2003. Recent studies support a revised model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360°complete inner circular layer and a 300°incomplete outer longitudinal coat. Additional studies show a more sophisticated venous drainage system than previously understood, and most significantly, that the emissary veins can be easily occluded by the shearing action elicited by the inner and outer layers of the tunica albuginea. Pascal's law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity. Reports on revascularisation surgery support its utility in treating arterial trauma in young males, and with localised arterial occlusive disease in the older man. Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been
Erectile Dysfunction and Coronary Artery Disease-the Practice Points
2020
Coronary artery disease (CAD) is a leading cause of morbidity and death. Erectile dysfunction (ED) and Coronary artery disease (CAD) share a common pool of risk factors. Risk factors such as Diabetes, Hypertension, smoking and alcohol consumption display a significant co-relation with ED; and these patients are almost three times more likely to have a coronary blockade when compared to those not reporting ED. A complex interplay between Atherosclerosis, Vascular inflammation and endothelial dysfunction mark the pathophysiological cascade that underlies these disorders, with endothelial dysfunction being the major component affecting different vascular beds of various diameters. Endothelial dysfunction plays a key role in the progression of atherosclerosis, contributing to exaggerated intimal proliferation and dysregulation of the inflammatory processes. It has been well studied that patients with ED tend to develop a severe CAD with multiple vessel involvement compared to those with...
Erectile Dysfunction As a Generalized Vascular Dysfunction
Journal of the American Society of Echocardiography, 2006
We hypothesize that generalized vascular dysfunction may be the underlying cause in patients with erectile dysfunction (ED) without atherosclerosis and its major risk factors. Methods: In all, 30 outpatients with ED and 25 healthy volunteers as a control group were enrolled for this study. Aortic stiffness was calculated from data obtained by echocardiographic examination, which was performed using commercially available equipment with a 2.5-to 3.5-MHz transducer. Endothelium-dependent flow-mediated dilation (FMD) of the brachial artery was assessed using a high-resolution ultrasound system with a 10-MHz linear-array vascular transducer. Shear stress and nitroglycerin was used as a stimulus for assessing endotheliumdependent FMD and nonendothelium-dependent dilation of the brachial artery. Results: FMD was significantly decreased in the ED group compared with control group (4.1 ؎ 3.1% vs 9.7 ؎ 3.5%, P < .001). Nonendothelium-dependent dilation was statistically insignificant in patients with ED compared with control subjects (13 ؎ 3.9% vs 15.4 ؎ 3.8%, P ؍ .55). The relationship between ED and FMD was significant (r ؍ ؊0.66, P < .001), whereas no relationship was found between ED and nonendothelium-dependent dilation (r ؍ ؊0.23, P > .05). Aortic strain (3.7 ؎ 2.7% vs 9.5 ؎ 3.2%, P < .001) and distensibility (1.5 ؎ 1.0 vs 4.7 ؎ 2.9 cm 2 .dyne ؊1 .10 ؊3 , P < .001) were found significantly lower in the ED group than in the control group. The relationship between ED and aortic stiffness was also significant (for aortic strain; r ؍ ؊0.62, P < .001 and for aortic distensibility; r ؍ ؊0.60, P < .001). Conclusion: Aortic and brachial artery functions are impaired in men with ED without cardiovascular disease or its major risk factors, indicating a more generalized vascular disease.