DETERMINATION OF LESION SEVERITY IN PATIENTS WITH PERIPHERAL ARTERIAL DISEASE: A COMPARISON OF COMPUTED TOMOGRAPHIC ANGIOGRAPHY TO CATHETER-BASED ANGIOGRAPHY WITH INTRAVASCULAR ULTRASOUND AS THE GOLD-STANDARD

Introduction: Erectile dysfunction (ED) affects more than 150 million men worldwide, with deleterious effects on quality of life. ED is known to be associated with ischemic heart disease but the impact of ED in patients with peripheral arterial disease (PAD) is unknown. We assessed the prevalence and severity of ED in patients with PVD. Methods: Following ethical approval, sequential male patients diagnosed with PAD over a 1-year period following diagnosis of intermittent claudication. The patient demographics and comorbidities were recorded, with the International Index of Erectile Function (IIEF-5) questionnaire used to grade severity of ED. Computed tomographic angiography and severity of stenosis in the proximal vessels and internal pudendal arteries were correlated using a modified Bollinger Matrix scoring system. Results: 60 patients were recruited, most (77.2%) reported erectile dysfunction (52.5% severe, 22.5% moderate). Patients with severe ED were more likely to have 2 or more comorbidities (P = .009). 86.7% with severe ED had bilateral internal pudendal artery stenosis with a mean modified Bollinger score of 17.6. 35.5% of moderate ED patients had bilateral internal pudendal stenosis with a mean Bollinger score of 11.75. There was significant difference in overall scores between moderate and severe erectile dysfunction (p< 0.05), thus indicating a potential link between ED severity and extent of vessel stenosis. Conclusion: There is a substantial burden of clinically significant ED among patients with PAD. This study suggests ED should be discussed with all PAD patients and ED may precede a PAD diagnosis. There is scope for endovascular revascularization as a treatment option for ED secondary to arterial insufficiency.

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Diagnostic workup and endovascular treatment of popliteal artery trauma

VASA ◽

10.1024/0301-1526/a000756 ◽

2019 ◽

Vol 48 (1) ◽

pp. 65-71 ◽

Cited By ~ 1

Author(s):

Cheong J. Lee ◽

Rory Loo ◽

Max V. Wohlauer ◽

Parag J. Patel

Keyword(s):

Vascular Injury ◽

Gold Standard ◽

Imaging Techniques ◽

Computed Tomographic Angiography ◽

Vascular Trauma ◽

Endovascular Techniques ◽

Computed Tomographic ◽

Arterial Injuries ◽

Arterial Trauma ◽

Peripheral Arterial

Abstract. Although management paradigms for certain arterial trauma, such as aortic injuries, have moved towards an endovascular approach, the application of endovascular techniques for the treatment of peripheral arterial injuries continues to be debated. In the realm of peripheral vascular trauma, popliteal arterial injuries remain a devastating condition with significant rates of limb loss. Expedient management is essential and surgical revascularization has been the gold standard. Initial clinical assessment of vascular injury is aided by readily available imaging techniques such as duplex ultrasonography and high resolution computed tomographic angiography. Conventional catheter based angiography, however, remain the gold standard in the determination of vascular injury. There are limited data examining the outcomes of endovascular techniques to address popliteal arterial injuries. In this review, we examine the imaging modalities and current approaches and data regarding endovascular techniques for the management popliteal arterial trauma.

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