Microsurgical arterialization for vascular impotence

Abstract

Out of 400 patients with erectile lesions, Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phalloarteriography in 22 males demonstrated an occlusion of the interna pudendal artery in 21. In 15 patients penile arterialization was done by interposition of a saphenous vein-graft between the iliac artery and the deep dorsal penile vein. In four of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively, two of three of the patients are doing well. Failures in five included four diabetic neurovascular lesions and one postoperative priapism.

Penile revascularization surgery for arteriogenic erectile dysfunction: the long‐term efficacy rate calculated by survival analysis

“…The subjectively reported efficacy of penile revascularization surgery is 40-85% [18][19][20][21][22][23][24]. These authors noted that prolonged patency of the anastomosis requires a technically sound procedure and that the afferent epigastric artery must not be kinked but linear.…”

High-Flow Priapism and Glans Hypervascularization following Deep Dorsal Vein Arterialization for Vasculogenic Impotence

“…Until a reliable technique is developed to predict the effect of vacular manipulations, postoperative pria pism will remain a potential complication of penile revas cularization. Unfortunately, the remedy, ligation or band ing of all or part of the anastomosis, often results in the return of impotence [5,6], Transcatheter embolization, applied successfully in other forms of high-flow priapism [10], might be useful here as well.…”

“…Arterialization of the deep dorsal vein by anasto mosis with a vein graft from the femoral artery was first described by LeVeen and Diaz [2], Virag [4] has compiled six variations of the procedure (table 1). Deep dorsal vein arterialization (DDVA), though a therapeutic improve ment over Michal's procedure, can still be associated with priapism [5,6]. Another potential complication of DDVA is glans hypervascularization [7].…”