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.