SIR 2024
Venous Interventions
Elizabeth Von Ende, DO
Interventional Radiology Independent Resident
Ohio State University Wexner Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Mina S. Makary, MD (he/him/his)
Interventional Radiologist
The Ohio State University Wexner Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
To review the pre-procedural clinical work-up, procedural technique, and post-procedural outcomes of venous leak embolization in the setting of venogenic erectile dysfunction (ED).
Background: ED affects approximately 30 million men in the United States and over 150 million worldwide, increasing in prevalence with age, with the potential to significantly impact quality of life. It is defined as the repeated inability to achieve or maintain an erection for satisfactory sexual intercourse, with the most common etiology being vasculogenic. Venogenic ED is due to insufficient penile blood retention during erection secondary to venous leakage, usually involving the periprostatic veins and internal and external pudendal veins. Previous treatment options for venogenic ED included surgical ligation of the deep dorsal penile vein and its collaterals; however, the success rate is only 25%. More recently, transcatheter venous embolization has been described as a safe and promising treatment for venogenic ED. Optimal outcomes are likely dependent on appropriate patient selection, careful technique employment, and comprehensive clinical management.
Clinical Findings/Procedure Details: This exhibit will 1) illustrate patient selection as well as pre-procedural clinical and imaging evaluation including the International Index of Erectile Function-15 (IIEF-15) questionnaire, color Doppler flow analysis, CT cavernosography for appropriate patient selection, and pertinent vascular anatomy; 2) summarize the procedural techniques for venous leak embolization including both antegrade and retrograde approaches; 3) review the common embolic agents utilized, treatment endpoints, and problem-solving common pitfalls; 4) discuss associated procedural complications and risks; and 5) present literature, treatment outcomes, and future studies.
Conclusion and/or Teaching Points: After reviewing this exhibit, the viewer will gain a deeper understanding of the endovascular management of venogenic erectile dysfunction including the importance of adequate pre-procedural evaluation, endovascular techniques and pearls, and current treatment outcome data.