Previous histologic and phalloarteriographic studies that we have performed suggest that stenoses and occlusions of the arteries supplying the penis play a very important role in the etiology of sexual impotence in many patients. This report describes the results of direct arterial anastomosis to the cavernous bodies of the penis, using the inferior epigastric artery and microsurgical technique, in 21 impotent males ranging in age from 40 to 63 years. The objective of the operation was to increase basal penile blood flow to a level, determined by preoperative studies, just below that necessary to maintain an effective erection. A limited capacity to increase blood flow in response to an erotic stimulus could then suffice to produce an erection. The anastomosis became occluded in 6 patients, and the complication of priapism developed in 3. The bypass remained patent in 13 patients, 11 of whom experienced improved erection. Nine patients resumed normal sexual activity that, prior to operation, was impossible.
An angiographic method has been developed for x-ray visualization of the arteries supplying the cavernous bodies of the penis, namely, the internal iliac, internal pudendal, and penile artery and its branches (dorsal, deep, and bulbocavernous arteries). Under normal conditions the technique makes pulsations in both dorsal penile arteries palpable, and the flow rate of fluid into the cavernous bodies necessary to produce and maintain erection can be determined. The principle of the method involves artificial passive erection or semierection, during which we perform selective or semiselective arteriography of the bed supplied by the internal iliac artery, or retrograde arteriography by puncture of the dorsal artery of the penis.Thirty males complaining of more than 1 year of impotence (including 12 diabetics) were investigated, 29 by our standard technique and 1 by translumbar pelvic arteriography with retrograde arteriography of the dorsal penile artery. All patients showed severe stenosis or obliteration of the vessels supplying the cavernous bodies. There was agreement between absence of pulsation in the dorsal penile arteries and the angiographic findings. Flow rates necessary to produce erection varied from 45 to 160 ml/min, with a mean of 90 ml/min. For controls, angiographic studies were performed in 4 men with clearly psychogenic impotence, all of whom were found to have normal-appearing arteries supplying the cavernous bodies.On the basis of these findings and previously reported histological investigations, we believe that most impotence is the symptomatic and functional result of arterial disease. The arteriographic technique described allows a precise anatomical diagnosis to be made, and can indicate surgical and microsurgical correction.
<b><i>Introduction:</i></b> Periprocedural stroke represents a rare but serious complication of cardiac catheterization. Pooled data from randomized trials evaluating the risk of stroke following cardiac catheterization via transradial versus transfemoral access showed no difference. On the other hand, a significant difference in stroke rates favoring transradial access was found in a recent meta-analysis of observational studies. Our aim was to determine if there is a difference in stroke risk after transradial versus transfemoral catheterization within a contemporary real-world registry. <b><i>Methods:</i></b> Data from 14,139 patients included in a single-center prospective registry between 2009 and 2016 were used to determine the odds of periprocedural transient ischemic attack (TIA) and stroke for radial versus femoral catheterization via multivariate logistic regression with Firth’s correction. <b><i>Results:</i></b> A total of 10,931 patients underwent transradial and 3,208 underwent transfemoral catheterization. Periprocedural TIA/stroke occurred in 41 (0.29%) patients. Age was the only significant predictor of TIA/stroke in multivariate analysis, with each additional year representing an odds ratio (OR) = 1.09 (CI 1.05–1.13, <i>p</i> < 0.000). The choice of accession site had no impact on the risk of periprocedural TIA/stroke (OR = 0.81; CI 0.38–1.72, <i>p</i> = 0.577). <b><i>Conclusion:</i></b> Observational data from a large prospective registry indicate that accession site has no influence on the risk of periprocedural TIA/stroke after cardiac catheterization.
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