Effects of pan-pelvic endovascular intervention on erectile function: results of computed tomographic angiography and 12-month clinical follow-up from the all-comer PERFECT registry
Wang, TD1; Lee, WJ1; Chang, YK1; Liu, SP1
1: National Taiwan University Hospital, Taiwan
Objectives: Pelvic arterial stenotic disease is an essential cause of erectile dysfunction. We herein reported the angiographic and 12-month clinical outcomes of “pan-pelvic” endovascular intervention in patients with erectile dysfunction from the all-comer PERFECT registry.
Material and Methods: Patients with erectile dysfunction and obstructive pelvic arterial lesions (unilateral diameter stenosis ≥70% or bilateral stenoses ≥50%) undergoing “complete” angioplasty and follow-up multi-detector pelvic computed tomographic (CT) angiography were enrolled. The primary endpoints included in-segment binary restenosis (diameter stenosis ≥50%) by follow-up pelvic CT angiography at 8 months and sustained clinical success in erectile function (International Index for Erectile Function-5 [IIEF-5] score ≥22 or change in IIEF-5 ≥4 and without a later decline by ≥4) at 12 months.
Results: A total of 182 consecutive patients (mean age 62.6±7.9 years [range, 42-83 years]) with 334 obstructive segmental lesions (1.8 lesions/patient) and an average IIEF-5 score of 9.1±4.4 were enrolled. One hundred and twelve (34%) obstructive lesions were treated with stenting in addition to balloon angioplasty. At 8 months, the CT angiographic binary restenosis occurred in 102 lesions (102/334, 31%) and 76 patients (76/182, 42%). For lesions located in the proximal internal pudendal artery and above, binary restenosis occurred in only 4 of 113 lesions (3.5%), whereas for lesions located in the distal internal pudendal artery and beyond, binary restenosis occurred in 98 of 221 lesions (44%). Sustained clinical success in erectile function was achieved in 112 (62%) patients at 12 months, with an overall improvement in IIEF-5 of 5.7±4.7 (p<0.001). Among patients not developing any binary restenosis, 82% (87/106) achieved sustained clinical success in erectile function, whereas for patients with binary restenosis, 33% (25/76) achieved sustained improvement in erectile function. There were no adverse events except two cases with restenosis experiencing transient worsening of erectile function during follow-up.
Conclusions: In this real-world registry, we for the first time demonstrated the feasibility and effectiveness of complete pelvic arterial endovascular revascularization in the amelioration of erectile dysfunction. The low restenosis rate (<4%) for lesions located in the proximal internal pudendal and iliac arteries and the above 80% sustained clinical success rate in patients not developing restenosis are encouraging. However, for lesions located in the distal internal pudendal and penile arteries, the 40-50% restenosis rate remains a hurdle and quests for further refinement of contemporary intervention strategies.
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