Lesion Pattern in Patients With Erectile Dysfunction of Suspected Arterial Origin: An Angiographic Study.
OBJECTIVE
To determine the specific lesion pattern of supplying arteries in patients with cardiovascular risk factors suffering from treatment-refractory erectile dysfunction (ED).


METHODS
From May 2012 to August 2013, 26 men (median age 55 years) poorly responsive to phosphodiesterase-5 inhibitor therapy were evaluated for a possible vascular cause for their ED. The men were examined with penile duplex sonography and digital subtraction angiography (DSA). Arterial lesions in the common and internal iliac arteries and the internal pudendal arteries considered amenable to endovascular therapy were treated with angioplasty ± stents. Retrospectively, 2 blinded investigators independently evaluated the DSA images and categorized the vascular patterns of the erection-related arteries as normal, macroangiopathy (occlusive lesions of the internal pudendal arteries), or microangiopathy (smaller caliber arteries distal to the internal pudendal circulation with no distal arterial reconstitution).


RESULTS
Seventeen macroangiopathic lesions were successfully treated by angioplasty in 11 patients. The treated arterial lesions were mainly located in the internal (n=10) and common iliac arteries (n=2), whereas the internal pudendal artery were involved in 5 cases. Microangiopathic lesions lacking distal reconstitution were present in 7 patients, and the remaining 8 patients had normal vessels supplying the penis. Patients with macroangiopathy undergoing angioplasty had a higher prevalence of peripheral artery disease (63.6% vs 6.7%, p=0.003).


CONCLUSIONS
In this preliminary series of ED patients with cardiovascular risk factors and pathologic duplex sonographic flow parameters, roughly 40% exhibited arterial lesions amenable to endovascular revascularization. In the patients with macroangiopathy, vessels upstream of the internal pudendal artery were most commonly affected. More studies are warranted to define the role of endovascular procedures in this ED subpopulation.
Clinic for Vascular Surgery, Kantonsspital St Gallen, Switzerland.
Regula S
RS
von Allmen
Department of Urology, University Hospital Bern and University of Bern, Switzerland.
Daniel P
DP
Nguyen
Department of Urology, University Hospital Bern and University of Bern, Switzerland Urologie St. Anna, Hirslanden Klinik St Anna, Lucerne, Switzerland.
Frédéric D
FD
Birkhäuser
Clinical and Interventional Angiology, University Hospital Bern and University of Bern, Switzerland.
Rudolf
R
Bednar
Clinical and Interventional Angiology, University Hospital Bern and University of Bern, Switzerland.
Rafael
R
Kammer
Clinical and Interventional Angiology, University Hospital Bern and University of Bern, Switzerland.
Dai-Do
DD
Do
Clinical and Interventional Angiology, Kantonsspital Aarau, Switzerland University of Applied Sciences, Furtwangen, Villingen-Schwenningen, Germany nicolas.a.diehm@gmail.com.
Nicolas
N
Diehm
D000368:Aged; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000295:instrumentation; D003251:Constriction, Pathologic; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D058729:Peripheral Arterial Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex
D058986:Phosphodiesterase 5 Inhibitors
angioplasty; cardiovascular disease; erectile dysfunction; internal iliac artery; internal pudendal artery; microangiopathy; occlusion; peripheral artery disease; stenosis; stent