Vascular interventions for impotence: Lessons learned

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Presentation transcript:

Vascular interventions for impotence: Lessons learned Ralph G. DePalma, MD, Michael Olding, MD, George W. Yu, MD, Frederick J. Schwab, MD, Edward M. Druy, MD, Harry C. Miller, MD, Elizabeth Massarin, BA, RT Journal of Vascular Surgery Volume 21, Issue 4, Pages 576-585 (April 1995) DOI: 10.1016/S0741-5214(95)70189-3 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Aortoiliac aneurysm and associated penile pulse volume recordings and penile brachial indexes. Aneurysm in 60-year-old man complaining of abrupt onset of impotence. Aortic aneurysm diagnosed 8 months before with abdominal component measured at 3.6 cm compared with suprarenal aortic diameter of 3 cm. Enlargement to 4.5 cm prompted operation. Small aneurysm at bifurcation of right common iliac artery appeared to relate to absent penile Doppler signals and penile brachial index of 0 on right. Penile pulse volume waves with delayed upstroke and sine waveform before and after operation suggest ipsilateral embolism. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Technical variations used in microvascular reconstruction of dorsal penile artery with inferior epigastric artery used as inflow source. 19 Choice is based on arteriographic and operative findings. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Technique of deep dorsal vein arterialization with use of Furlow-Fisher 20 technique. Note blood flow in emissary vein these drain mainly into spongiosum. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Plethysmographic pulse wave recordings. A, Before operation in 42-year-old man with diffuse penile arterial disease. B, After deep dorsal vein arterialization. Note absence of waveforms before operation with normal wave forms 9,10 after operation. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Cavernosogram shows deep dorsal vein leakage. Preoperative flow to maintain erection was 110 ml/min in 48-year-old man. Patient reports spontaneous function 4 years after dorsal venous ligation and excision. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Diffuse cavernosal leakage in 38-year-old man who had never achieved normal erection, in spite of two attempts at embolization, dorsal vein excision, and suprapubic excision and ligation of veins. FME of 180 ml/minute before operation fell to only 80 ml/minute after operation. Patient remains nonfunctional; pudendal arteriogram is normal. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Cumulative erectile function rate by life-table representation, including men using ICI or VCD. A, Aortoilac disease. B, Dorsal penile artery bypass. C, Deep dorsal vein arterialization. D, Venous interruption. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Cumulative erectile function rate by life-table representation, including men using ICI or VCD. A, Aortoilac disease. B, Dorsal penile artery bypass. C, Deep dorsal vein arterialization. D, Venous interruption. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Cumulative erectile function rate by life-table representation, including men using ICI or VCD. A, Aortoilac disease. B, Dorsal penile artery bypass. C, Deep dorsal vein arterialization. D, Venous interruption. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Cumulative erectile function rate by life-table representation, including men using ICI or VCD. A, Aortoilac disease. B, Dorsal penile artery bypass. C, Deep dorsal vein arterialization. D, Venous interruption. Journal of Vascular Surgery 1995 21, 576-585DOI: (10.1016/S0741-5214(95)70189-3) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions