Abstract：
Background: The extent of arterial disease in patients with erectile dysfunction (ED) non-responsive to intracavernosal injection of Alprostadil is of importance for therapeutic options. However, published evidence, in particular angiographically validated is scarce. Here we investigated arterial lesion patterns in this specific patient cohort by selective angiography. Patients and methods: A cohort of 239 patients received a clinical and duplex-sonographic workup for ED of suspected vascular origin. Duplex ultrasound of the cavernosal arteries was performed after intracavernosal injection of 10 μg Alprostadil. Consequently, standardized workup included grading of the erectile and determination of peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both cavernosal arteries. PSV-values below 30 cm/sec indicated reduced arterial flow, whereas EDV-values above 15 cm/sec indicated a venous leak of the pudendal veins. All patients with suspected arterial ED based on duplex sonography underwent contrast-enhanced computed tomography. Endovascular therapy was carried out in ED patients not responsive or with significant side effects to PDE-5-inhibitors or Alprostadil by selective angiographic depiction of erection-related arteries. Results: 54 patients with a mean age of 61.2 (±9.8) years underwent angioplasty of erectionr elated arteries. Out of these 48/54 (89%) patients presented with an erection considered insufficient for penetration (E0-E3) subsequent to intracavernous application of 10 μg Alprostadil. 14/48 (29%) patients had bilateral arterial obstructions and 34/48 (71%) had unilateral disease. Commonly affected was the internal pudendal artery (n = 31, 65%), followed closely by the common penile artery (n = 30, 64%). The least affected arteries were the dorsal penile (n = 6, 13%), hypogastric (n = 4, 8%), common iliac (n = 4, 8%), cavernosal (n = 4, 8%), and inferior gluteal (n = 1, 2%) arteries. Conclusions: Arterial obstructions amenable to endovascular revascularization are frequent in patients non-responsive to intracavernosal prostaglandin administration. Therapeutic strategies in ED patients non-responsive to conservative measures should therefore consider endovascular treatment opportunities.
摘要：
背景：对海绵体内注射前列地尔无反应的勃起功能障碍（ED）患者的动脉疾病程度对于治疗选择很重要。然而,公布的证据,特别是在血管造影验证是稀缺的。在这里，我们通过选择性血管造影研究了该特定患者队列中的动脉病变模式。患者和方法：239名患者接受了疑似血管起源ED的临床和双工超声检查。海绵体内注射10μg前列地尔后，进行海绵体动脉的双重超声检查。因此,标准化检查包括两个海绵体动脉的勃起分级以及收缩期峰值速度（PSV）和舒张末期速度（EDV）的测定。PSV值低于30厘米/秒表明动脉流量减少，而EDV值高于15cm/sec表示阴部静脉渗漏。所有基于双工超声检查的可疑动脉ED患者均接受了对比增强计算机断层扫描。通过对勃起相关动脉的选择性血管造影描绘，对对PDE-5抑制剂或前列地尔无反应或有明显副作用的ED患者进行了血管内治疗。结果：54例平均年龄为61.2（±9.8）岁的患者接受了勃起动脉的血管成形术。在这48/54（89％）的患者中，在海绵体内施用10μg前列地尔后，勃起被认为不足以渗透（E0-E3）。14/48（29％）患者有双侧动脉阻塞，34/48（71％）有单侧疾病。通常受影响的是阴部内动脉（n=31，65％），其次是阴茎总动脉（n=30，64％）。受影响最小的动脉是阴茎背（n=6，13％），胃下（n=4，8％），髂总（n=4，8%），海绵体（n=4，8%），和臀下动脉（n=1，2％）。结论：在对海绵体内前列腺素给药无反应的患者中，易于血管内血运重建的动脉阻塞很常见。因此，对保守措施无反应的ED患者的治疗策略应考虑血管内治疗机会。
