Transradial access for the treatment of erectile dysfunction

1. Transradial access for the treatment
of erectile dysfunction
Zoltán Ruzsa MD PhD
AimRadial 2015
Liverpool

2. Disclosure Statement of Financial Interest
I, Zoltán Ruzsa MD. PhD. DO NOT have a
financial interest/arrangement or affiliation with
one or more organizations that could be
perceived as a real or apparent conflict of
interest in the context of the subject of this
presentation.

3. Background- Definition
• Inability to achieve and maintain an erection
satisfactory for sexual intercourse

4. Background- Etiology
• 80% vasculogenic
• Traumatic
• Post-surgical
• Hormonal
• Chronic disease
• Medication
• Psychological
Cavernosal Smooth Muscle Relaxation
Arterial inflow
Venous leak
Lue. NEJM 2000.342:1803

5. ED and all-cause mortality

6. Coronary artery disease and ED
• ED and CAD
– Penile PSV ≤35 predicts CAD with1oo% sensitivity
– ED pts has positive stress test in 8-56%
– ED pts has higher Ca score at MSCT
• CAD and ED
– CAD pts has ED in 45-7o%

7. Therapy for ED
PDE-5 Inhibitor Oral Therapy
Up to 50% Discontinuation
Penile Injection
Vacuum and Constriction Device
Intrauretral Suppository
Penile Prothesis
Sildenafil, Vardenafil, Tadalafil

8. Intervention for ED
• Common and internal iliac angioplasty 1,2
• Pudendal angioplasty 3
• ZEN trial (Zotarolimus DES for ED)
• Penile angioplasty 4
• PERFECT-1 trial
1. Gur S et al. Cardiovasc Intervent Radiol. 2013 Feb;36(1):84-9.
2.Gür S et al. Korean J Radiol. 2013 Jan-Feb;14(1):81-5.
3. Rogers et al. JACC 2o12
4. Tzung-Dau Wang et al. Eurointervention 2o14

9. ZEN Trial
Primary and secondary end-points
Freedom from MAE 1oo%
IIEF improvement 59.3%
Restenosis 34.4%

10. IIEF score and PSV over time

11. Perfect trial

12. Procedure results

13. Clinical outcomes

14. Femoral access for IIA lesions
• Contralateral access
• Retrograde access
IIA dissection and occlusion 9%
Jip F Prince et al. Plos One

15. Radial access for Iliac
intervention
• ADVANTAGES
– Good pushability
– Axial orientation of the sheath
– Easy cannulation of the IIA
– No femoral artery complications
• DISADVANTAGES
– You need to pass the aortic arch
(Stroke risk)
– Radial artery access has
limitations
– Relative high rate of minor
vascular complications
– Not all devices are available with
long shaft (>135 cm)

16. Methods: Angioplasty
• Transradial access with 5F TR sheath
• Aortography- Pig Tail 12o cm
• Sheathless guiding 12o cm 6F, angulated
• Selective cannulation of the IIA with MP 125 cm catheter
• Angiography
– Papaverin ia to rule out venous leak
• Angioplasty
– CIA- o.o35 GW and Omnilink stent
– IIA- o.o18 V18 GW and Sterling balloon, BE stent with 135 shaft
(Omnilink Elite)
– Pudendal artery- o.o18 V18 GW and Sterling. Herculink stent
– Penile artery- o.14 coronary GW, balloon and stent (DES)
(long shaft coronary monorail balloon 15o cm)
Immediate mobilisation and 6 hours hospital stay!!!!

17. Results
• Intervention
– CIA: 8
– EIA: 5
– Pudendal artery: 5
– Penile artery: 5
• Procedure success: 23 (1oo%)
• Clinical success: 16 (69.5%)
• Complications
– MAE: o (o%)
– Vascular complication: o (o%)
– Procedure releated complication: 1 (4.3%)
(distal penile artery perforation)

18. Treatment 1-
Internal iliac and pudendal angioplasty from radial access

23. Treatment 2 – Penile CTO recanalisation

31. Conclusion
• We must screen patients with CAD and PAD for ED
and vica versa patients with ED must undergone
cardiological test
• ED team is necessary between radiologist,
cardiologist, urologist
• Transradial access with long sheathless guiding is
feasible and safe technique for treating iliac and
pudendal arteries

32. Thank you for your attention

33. Diagnostic-
Ultrasonography
• Venous leak (Veno-occlusive insuffitiency)
• Bilateral Doppler waveforms of the cavernosal
arteries at 25 min post-injection of PGE
demonstrate a high peak systolic velocity (>40
cm/s), which excludes arterial insuffienciency as a
cause of ED in the patients
• A persistent distolic flow velocity more than 5 cm/s
is suggestive a venous leak

34. Ultrasound
• Duplex U/S: measures a penile blood flow, most
reliable and least invasive assessment of ED
• Color Doppler US: measures a PSV (n >40 cm/s) and
end distolic velocity (n < 5 cm/s)
• Cavernosonography: measures penile blood flow
following intracavernal inf of contrast and induction
of arterfitial erection. Can identify venous leakage.