Bertolotto M, Zappetti R, Pizzolato R, Liguori G
Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
Acta Radiol. 2008 Jul;49(6):710-4. doi: 10.1080/02841850802027026.
Superselective embolization of the torn artery is currently considered the treatment of choice for patients with high-flow priapism. After embolization, however, the arterial-sinusoidal fistula is still patent in a significant percentage of patients, despite arteriographic evidence of occlusion.
To investigate the prevalence and flow characteristics of penile cavernosal-spongiosal communications (CSCs) in patients with high-flow priapism, and to establish whether the recognition of these vessels before and after angiographic embolization has a role in predicting the outcome of therapy.
Twelve consecutive patients with high-flow priapism underwent penile color Doppler ultrasound before and after angiographic embolization of the arterial-sinusoidal fistula. The prevalence of CSCs feeding the fistula was evaluated before and after embolization.
Before angiographic embolization, color Doppler ultrasound identified five CSCs in 3/12 patients. One CSC was proximal to the fistula, and 4/5 were distal. After angiographic embolization, the fistula was not completely closed in these patients, fed by the distal CSCs. However, spontaneous closure occurred within 1 month. The fistula was also fed by CSCs in another two patients in whom these vessels were not evident before embolization. In one case, the fistula closed spontaneously within 1 week, while in the other case the fistula remained patent, fed by other collateral vessels.
The type of vessels that are involved in refilling the fistula after embolization is of concern for the outcome of the patients. In our series, the fistulas supplied only by CSCs closed spontaneously within 1 month. Watchful waiting should be preferred to repeated embolization to avoid the risk of unnecessary procedures.
目前，对于高流量性阴茎异常勃起患者，撕裂动脉的超选择性栓塞被认为是首选治疗方法。然而，栓塞后，尽管血管造影显示动脉闭塞，但仍有相当比例的患者动脉-海绵窦瘘仍保持通畅。
研究高流量性阴茎异常勃起患者阴茎海绵体-海绵体间交通支（CSC）的发生率及其血流特征，并确定血管造影栓塞前后对这些血管的识别是否有助于预测治疗结果。
对12例连续的高流量性阴茎异常勃起患者在动脉-海绵窦瘘血管造影栓塞前后进行阴茎彩色多普勒超声检查。评估栓塞前后为瘘管供血的CSC的发生率。
在血管造影栓塞前，彩色多普勒超声在3/12例患者中发现了5条CSC。1条CSC位于瘘管近端，4/5位于远端。血管造影栓塞后，这些患者的瘘管未完全闭合，由远端CSC供血。然而，在1个月内瘘管自发闭合。另外2例患者的瘘管也由CSC供血，而在栓塞前这些血管并不明显。1例患者的瘘管在1周内自发闭合，另1例患者的瘘管仍保持通畅，由其他侧支血管供血。
栓塞后参与瘘管再充盈的血管类型与患者的治疗结果相关。在我们的系列研究中，仅由CSC供血的瘘管在1个月内自发闭合。应首选密切观察而非重复栓塞，以避免不必要的手术风险。
