Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan.
Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
J Clin Hypertens (Greenwich). 2021 Mar;23(3):481-488. doi: 10.1111/jch.14123. Epub 2020 Dec 14.
The prevalence of erectile dysfunction (ED) is above 40% in both Asian and non-Asian male populations after the age of 40 years. The prevalence of ED among hypertensive patients is approximately double than that in normotensive population. Pelvic arterial insufficiency is the predominant cause of ED in men aged over 50 years. Stenosis in any segment of the iliac-pudendal-penile arterial system, which is considered an erectile-related arterial axis, could lead to ED. Pharmacotherapy with lifestyle modification is effective in alleviating sexual dysfunction, yet a substantial number of patients still develop ED. Given the established applicability of angioplasty for the entire iliac-pudendal-penile arterial system, penile duplex ultrasound, and pelvic computed tomography angiography could be considered as the routine screening tools in ED patients with poor response to phosphodiesterase-5 inhibitors. Endovascular therapy for pelvic arterial insufficiency-related ED has been shown to be a safe and effective treatment option in patients who have anatomically suitable vessels and functionally significant stenoses. Clinical improvement was achieved in over 60% of patients at one year following pelvic angioplasty in the PERFECT registry from Taiwan. A 30%-40% restenosis rate in distal internal pudendal and penile arteries remains a hurdle. Angioplasty for pelvic arterial occlusive disease could be considered as a viable approach to arteriogenic ED.
勃起功能障碍（ED）在亚洲和非亚洲 40 岁以上男性中的患病率均高于 40%。高血压患者的 ED 患病率约为血压正常人群的两倍。骨盆动脉功能不全是 50 岁以上男性 ED 的主要原因。髂-阴部-阴茎动脉系统任何节段的狭窄，被认为是与勃起相关的动脉轴，可导致 ED。药物治疗结合生活方式改变可有效缓解性功能障碍，但仍有相当数量的患者出现 ED。鉴于血管成形术对整个髂-阴部-阴茎动脉系统的适用性，阴茎双功能超声和骨盆 CT 血管造影可被视为 ED 患者对磷酸二酯酶-5 抑制剂反应不佳的常规筛查工具。血管内治疗对与骨盆动脉功能不全相关的 ED 已被证明是一种安全有效的治疗选择，适用于具有解剖学上合适血管和功能显著狭窄的患者。来自中国台湾的 PERFECT 注册研究显示，在接受骨盆血管成形术治疗一年后，超过 60%的患者获得了临床改善。远端阴部内和阴茎内动脉的再狭窄率为 30%-40%，仍然是一个障碍。对于骨盆动脉闭塞性疾病的血管成形术可被视为治疗动脉性 ED 的一种可行方法。
