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Objective: The purpose is to determine the incidence of erectile dysfunction (ED) in patients with aortoiliac occlusive disease and compare the change of ED after open surgery and endovascular repair. Materials and Methods: A prospective and comparative study in a single center from January 2013 to October 2015, 103 male patients admitted for extensive aortoiliac occlusive lesions. The erectile function (EF) was evaluated using a questionnaire. All patients filled out the questionnaire preoperatively and postoperatively after 1 year. Results: This study enrolled two groups: 48 patients underwent endovascular treatment and 55 patients underwent open surgery (aortofemoral or aorto-iliac bypasses). Preoperatively, 45.8% of patients were functionally impotent; there was no difference EF depending on the stage of peripheral arterial disease or the severity of obstructive aortoiliac lesions. Postoperative impotence was twice as common in those with minor dysfunction preoperatively, deterioration of EF occurred in 16.2% in the surgical group, and 2.1% in the endovascular group, with a very significant difference (P = 0.0001). In multivariate analysis, adjusted to preoperative EF was significantly more impaired postoperatively after median laparotomy (heart rate: 24.80 confidence interval = 95% [3.17–51.80], P < 0.0001). Conclusion: Sexual dysfunction is a frequent and often missed comorbidity in vascular surgery patients, especially after aortoiliac surgery. Hence, it must be diagnosed and evaluated in preoperatively in the choice of the therapeutic approach. For that endovascular treatment offers a less invasive alternative to open surgery and allows patients to maintain its sexual function intact and improve the quality of life.

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