The Role of Revascularization of the Profunda Femoris Artery in Vasculogenic Impotence

Abstract

Erectile dysfunction is a common disorder, but the underlying cause is difficult to clarify because the organic (endocrine, neurogenic, vasculogenic and iatrogenic) and psychological components are mixed. Vasculogenic impotence, due to penile vascular insufficiency, is a common symptom in patients with aortoiliac occlusive disease (Leriche’s syndrome).The aim of this clinical study was to investigate the hypothesis that revascularization of the profunda femoris artery in Leriche’s syndrome offers good results in vasculogenic erectile dysfunction. We investigated 22 men aged 50–65 years (mean 57.5 years) with vasculogenic impotence due to Leriche’s syndrome. Exclusion criteria were: age >70 years, comorbidities, such as diabetes mellitus (DM), heart failure, HIV, history of perineal trauma and medication associated with erectile dysfunction (i.e., antidepressants, anxiolytics, antiandrogenics, anticholinergics). After clinical examination, measurement was made of the angle brachial pressure index (ABPI) and the penis brachial pressure index (PBPI) with duplex ultrasonography (U/S). All the patients underwent vascular imaging: 15 digital subtraction angiography (DSA) and 7 computed tomography angiography (CTA). Psychological investigation was carried out and the papaverine test was performed to exclude other causes of impotence. The patients underwent aorto-bifemoral bypass, with profundoplasty, if needed, and were followed for one year after operation with clinical examination and measurement of the ABPI and PBPI with duplex U/S. Preoperatively, all the patients reported absence of erectile function, with inability to achieve an erection of sufficient rigidity. Clinical examination revealed absence of pulses to peripheral arteries beyond the femoral arteries and absence of bruits in the iliac arteries. The ABPI ranged between 0.35 and 0.45 (normal: 1) and the PBPI between 0.2 and 0.32 (normal: 0.75). Aorto-bifemoral reconstruction (Y-Graft) with profundoplasty, if required, was performed on all patients. In 4 patients (group I) the peripheral arteries (common, profunda and superficial femoral artery) were not affected by atherosclerotic disease and profundoplasty was not required. In 18 patients (group II) profundoplasty was necessary because of atherosclerotic occlusion of the superficial femoral arteries and stenosis of the profunda artery. Postoperatively, in group I the ABPI became normal and the PBPI ranged between 0.5 and 0.6. In group II the ABPI ranged between 0.6 and 0.75 and the PBPI between 0.48 and 0.55. During the first month of the postoperative period 14 patients (4 from group I and 10 from group II) had normal erectile function (63.6 %) and during the late postoperative period (3-6 months of follow up) 5 more patients (2 from group I and 3 from group II) had improvement of the erectile function (22.7 %). No significant clinical improvement was observed in the other 3 patients (13.6 %). In patients with Leriche’s syndrome, revascularization of the profunda femoris artery (profundoplasty) ameliorates vasculogenic impotence through the improvement of the pelvic blood flow via the collateral circulation.