Early Recoil After Balloon Angioplasty of Erection-Related Arteries in Patients With Arteriogenic Erectile Dysfunction

To evaluate the incidence of elastic recoil in patients presenting with erectile dysfunction (ED) undergoing endovascular revascularization of the pudendal or penile arteries.

A consecutive series of 21 ED patients (mean age 58. 3±9.3 years) undergoing minimally invasive revascularization of 31 arteries was analyzed. ED lesions included the pudendal arteries (n=27) and the penile artery (n=4). Mean lesion length was 20.6±13.9 mm. Minimal lumen diameter (MLD) measurements were assessed at baseline, immediately after balloon angioplasty, and 10 minutes thereafter. Early recoil was defined as an MLD reduction >10%. Elastic recoil with >10% lumen compromise was treated with drug-coated balloons, while severe elastic recoil (>30%) required drug-eluting stents (DES). The International Index of Erectile Function (IIEF-15) score was obtained prior to and 3 months after the procedure to obtain information on functional outcomes subsequent to angioplasty.

Mean MLD at baseline was 0.9±0.6 mm, which improved to 2.0±0.9 mm immediately after balloon dilation. At 10 minutes after dilation, the MLD was 1.7±1.0 mm. Elastic recoil was observed in all 31 lesions and resulted in a mean lumen compromise of 21.2%. Severe (>30%) recoil was observed in 14 arteries, which underwent DES therapy. The IIEF-15 score improved from 31.3±11.2 at baseline to 49.8±16.8 (p<0.001) at the 3-month follow-up.

Endovascular revascularization constitutes a safe and feasible treatment modality to restore erectile function in patients with arteriogenic ED and ineffective conservative management. Early elastic recoil is very frequent subsequent to balloon dilation of small-caliber erection-related arteries. Thus, mechanical scaffolding with DES is required in a high subset of ED patients to provide favorable early angiographic and clinical results.

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2018 Oct 22 [Epub ahead of print]

Nicolas Diehm, Dai-Do Do, Hak-Hong Keo, Jana Boerlin, Christian Regli, Martin Schumacher, Pia M Jungmann, Lorenz Raeber, Frederic Baumann

1 Vascular Institute Central Switzerland, Aarau, Switzerland., 2 Department of Urology, Hirslanden Hospital Aarau, Switzerland., 3 Department of Neuroradiology, University Hospital of Zurich and University of Zurich, Switzerland., 4 Department of Cardiology, University Hospital of Bern, Switzerland., 5 Clinic for Angiology, University Hospital of Zurich and University of Zurich, Switzerland.