A normal penile pressure cannot rule out the presence of lesions on the arteries supplying the hypogastric circulation in patients with arterial claudication

Abstract

Proximal claudication remains a difficult diagnosis. The ankle to brachial index may be insensitive in the case of isolated hypogastric lesions. Penile pressure represents an alternative method for proximal arteries. Surprisingly, the accuracy of penile pressure measurement in detecting lesions on the arteries supplying pelvic circulation in patients suffering claudication has rarely been studied. We aimed to evaluate the diagnostic accuracy of the penile brachial index < 0.60 (penile over brachial systolic pressure ratio) to non-invasively investigate arteriographic lesions on arteries supplying the hypogastric circulation in 88 male patients referred for Fontaine stage II. The receiver operating characteristic (ROC) curve was used to define the diagnostic performance of the penile brachial index and search for a specific cut-off point in this population. Accuracy was 69.3% (95% confidence interval: 58.6-78.7) for the detection of an arterial stenosis or occlusion on at least one side. The penile brachial index </= 0.45 was 74% sensitive and 68% specific to discriminate the 19 patients with bilateral arterial occlusion from the other 66 patients. In conclusion, the penile brachial index is relatively insensitive for the detection of proximal abnormal blood flow impairment except in the case of bilateral occlusion of arteries supplying the hypogastric circulation in patients with claudication. A normal penile pressure is probably not efficient enough to rule out the presence of lesions on the arteries towards the hypogastric circulation in patients with arterial claudication.

Heart rate recovery after constant-load exercise tests is decreased in proportion to the importance (severity and diffusion) of exercise-induced lower-limb ischaemia

“…Indeed, ankle brachial index (ABI) cannot discriminate distal from proximo‐distal lesions or detect a perfusion impairment resulting from lesions of the hypogastric vascular bed. Last, neither penile pressure (Mahe et al. , 2009) nor near infrared spectrometry (Bouye et al.…”

“…Indeed, ankle brachial index (ABI) cannot discriminate distal from proximo-distal lesions or detect a perfusion impairment resulting from lesions of the hypogastric vascular bed. Last, neither penile pressure (Mahe et al, 2009) nor near infrared spectrometry (Bouye et al, 2005) satisfactorily estimates exercise-induced ischaemia at the buttock level. Our aim here was not to promote the use of tcpO2 in patients with PAD but to use the technique as a unique tool allowing for the estimation of both local severity and regional diffusion of exercise-induced ischaemia.…”

Exercise Transcutaneous Oximetry of the Buttocks ― External Validation With Computed Tomography Angiography ―

“…23 Similarly, penile pressure has a low diagnostic performance compared with arteriography. 24 CTA is now considered as the reference imaging technique for lower limb arterial investigation. The sensitivity of CTA was 95% and specificity, 96% compared with arteriography, 17 but CTA has some limits: the irradiation level is high and the contrast medium is nephrotoxic.…”

Patency of Direct Revascularisation of the Hypogastric Arteries in Patients with Aortoiliac Occlusive Disease

“…Although erectile dysfunction was observed in men, information concerning erectile function was not included because it was not consistently collected and because it was not relevant to the hypogastric circulation. 20…”