de Donato Gianmarco, Pasqui Edoardo, Gargiulo Bruno, Casilli Giulia, Ferrante Giulia, Galzerano Giuseppe, Cappelli Alessandro, Palasciano Giancarlo
Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Front Cardiovasc Med. 2022 Feb 28;9:847519. doi: 10.3389/fcvm.2022.847519. eCollection 2022.
Erectile dysfunction (ED) is defined as the recurrent inability to achieve and maintain a satisfactory erection for sexual intercourse. Many studies have highlighted that ED shares common cardiovascular risk factors with cardiovascular disease. No data are reported about the prevalence of ED in patients with the abdominal aortic aneurysm (AAA). The aim of our study was to investigate the preoperative information given about sexual functions of patients undergoing endovascular aneurysm repair (EVAR) and to compare it with the presence and severity of steno-occlusive atherosclerotic lesions of the pelvic arterial tree at pre-operative Computed Tomography Angiography (CTA).
We prospectively enrolled all men patients who underwent elective EVAR from September to November 2021. Preoperative ED was evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Preoperative imaging was routinely performed with CTA scan of the abdominal aorta and iliac-pelvic district. An innovative score of pelvic arterial disease associated to AAA was defined, dividing the iliac district in 4 zones attributing a grading of severity for each zone bilaterally (score ranges 0-24). Linear regression analysis was used to correlate IIEF-5 score to anatomical score of pelvic arterial steno-occlusive disease.
A total of 25 patients were enrolled. Median age was 74 ± 5.3 years. IIEF-5 average score was 14.8 ± 7.1. Eight cases (32%) had severe ED; one case (4%) had moderate, five patients (20%) had mild to moderate ED; five patients (20%) had mild ED, and 6 (24%) patients had no ED. CTA evaluation revealed an average anatomical score of 7.9 ± 4.5. Pelvic disease was considered moderate-severe in 20 cases (80%) and not significant in 20% (five cases). Linear regression analysis confirmed the hypothesis that a more diseased pelvic arterial tree was correlated to a more severe ED ( = -1.531 × + 26.35 [slope : -1.946 to -1.117, < 0.0001]).
Although typically unreported, the prevalence of ED associated to AAA was found to be high. A vasculogenic origin of ED in patients with AAA is plausible and may be easily confirmed by the evaluation of pelvic arterial distribution at angio-CT performed for EVAR planning. Our proposed "MAPPING AND SCORING SHEET" may help to identify the vasculogenic origin of ED in AAA patients.
勃起功能障碍（ED）被定义为反复无法实现并维持满意的性交勃起。许多研究强调，ED与心血管疾病有共同的心血管危险因素。目前尚无关于腹主动脉瘤（AAA）患者中ED患病率的报道。我们研究的目的是调查接受血管内动脉瘤修复术（EVAR）的患者术前关于性功能的信息，并将其与术前计算机断层扫描血管造影（CTA）时盆腔动脉树狭窄闭塞性动脉粥样硬化病变的存在情况及严重程度进行比较。
我们前瞻性纳入了2021年9月至11月期间接受择期EVAR的所有男性患者。使用国际勃起功能指数（IIEF-5）问卷评估术前ED情况。术前常规进行腹主动脉和髂盆腔区域的CTA扫描成像。定义了一种与AAA相关的盆腔动脉疾病创新评分，将髂区分为4个区域，双侧为每个区域赋予严重程度分级（评分范围0 - 24）。采用线性回归分析将IIEF-5评分与盆腔动脉狭窄闭塞性疾病的解剖学评分相关联。
共纳入25例患者。中位年龄为74±5.3岁。IIEF-5平均评分为14.8±7.1。8例（32%）患有重度ED；1例（4%）患有中度ED，5例（20%）患有轻度至中度ED；5例（20%）患有轻度ED，6例（24%）患者无ED。CTA评估显示平均解剖学评分为7.9±4.5。20例（80%）盆腔疾病被认为是中度至重度，20%（5例）不显著。线性回归分析证实了这样的假设，即盆腔动脉树病变越严重，ED越严重（=-1.531×+26.35[斜率：-1.946至-1.117，<0.0001]）。
尽管通常未被报道，但发现与AAA相关的ED患病率很高。AAA患者中ED的血管源性起源是合理的，并且可以通过为EVAR规划而进行的血管造影CT评估盆腔动脉分布来轻松证实。我们提出的“映射与评分表”可能有助于识别AAA患者中ED的血管源性起源。
