Arterial Endovascular Therapy for Erectile Dysfunction: patient selection, appropriate image evaluation, and pre- and postprocedural management.

1. Review the pathophysiology, presentation, and clinical indications for arterial endovascular intervention for ED.

2. Review pre procedural imaging evaluation, medical work up and selection

3. Review key anatomy, including anatomic variants. 

4. Review post procedure management, as well as postprocedural complications.

Background: Erectile dysfunction (ED) is the inability to attain or maintain penile erection for successful sexual intercourse. It results in significant reduction in quality of life for those affected. ED can be caused by multiple factors, one of which includes arterial inflow to the penile tissues. As such, arterial interventional strategies utilized in other body parts such as stenting, angioplasty, lithotripsy, laser atherectomy, thrombectomy, and IVUS, can be transferred to treat ED. Patients treated with endovascular arterial intervention display significant improvement in symptoms and quality of life.

Clinical Findings/Procedure Details: This exhibit will outline the normal and pathological states, presentation, and clinical features of erections and ED. The indications for arterial endovascular treatment of ED will be reviewed, as well as important contraindications. The imaging characteristics of treatable conditions with cross sectional imaging and ultrasonography will be illustrated. Key anatomic landmarks and structures (including important anatomic variants) will also be illustrated in pictorial fashion. Finally, common and uncommon postprocedural complications and their management will be reviewed.

Conclusion and/or Teaching Points: Arterial endovascular intervention for patients with ED improves symptoms and the quality of life for patients. It offers a minimally invasive solution to patients for patients who may have failed medical therapy and opted for surgical correction. ED carries a notable influence on quality of life, with significant implications for family and social relationships, especially given the overall aging population.  As such, interventional radiologists play an important role in providing relief to these patients and must understand the pre-, intra- and post-procedural aspects while planning their interventions.