Korean J Radiol.  2013 Feb;14(1):81-85. 10.3348/kjr.2013.14.1.81.

Impotence due to External Iliac Steal Syndrome: Treatment with Percutaneous Transluminal Angioplasty and Stent Placement

• Gur S
• Oguzkurt L
• Kaya B
• Tekbas G
• Ozkan U

• KMID: 1430047
• DOI: http://doi.org/10.3348/kjr.2013.14.1.81

Abstract

We report a case of erectile dysfunction caused by external iliac artery occlusion, associated with pelvic steal syndrome; bilateral internal iliac arteries were patent. The patient stated that he had experienced erectile dysfunction at similar times along with claudication, but he did not mention it before angiography. He expressed that the erectile dysfunction did not last long and that he felt completely okay after the interventional procedure, in addition to his claudication. Successful treatment of the occlusion, by percutaneous transluminal angioplasty and stent implantation, helped resolve erectile dysfunction completely and treat the steal syndrome.

Keyword

Erectile dysfunction; Pelvic steal syndrome; Percutaneous angioplasty

MeSH Terms

*Angioplasty
Arterial Occlusive Diseases/*complications/radiography/*therapy
Erectile Dysfunction/*etiology/*therapy
Humans
Iliac Artery/pathology/*radiography
Intermittent Claudication/complications
Male
Middle Aged
*Stents
Subclavian Steal Syndrome/*complications/*therapy

Figure

• 

  Fig. 1 53-year old man with right sided claudication and erectile dysfunction. A. Anteroposterior diagnostic pelvic angiography shows right external iliac artery occlusion and hypertrophied right internal iliac artery. Distal abdominal aorta was mildly aneurysmatic (3.6 cm in diameter). B. Left oblique diagnostic angiography shows right external iliac artery occlusion, hypertrophied right internal iliac artery, and collateral flow via dilated obturator (thick arrow) and medial femoral circumflex arteries (thin arrows) to right common femoral artery. C. Right oblique diagnostic angiography shows normal left main, internal, and external iliac arteries. D. After percutaneous transluminal angioplasty and stenting, angiogram shows normal calibration and excellent patency of right external iliac artery. Flow through right internal iliac artery slowed immediately, as a result of decrased volume. Right medial femoral circumflex artery was not seen on angiogram. E. Late phase of post-stent arteriography shows internal iliac artery branches better.

Reference

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994. 151:54–61.

2. Yassin AA, Saad F. Testosterone and erectile dysfunction. J Androl. 2008. 29:593–604.

3. Valji K, Bookstein JJ. Transluminal angioplasty in the treatment of arteriogenic impotence. Cardiovasc Intervent Radiol. 1988. 11:245–252.

4. Goldstein I, Siroky MB, Nath RL, McMillian TN, Menzoian JO, Krane RJ. Vasculogenic impotence: role of the pelvic steal test. J Urol. 1982. 128:300–306.

5. Goldwasser B, Carson CC 3rd, Braun SD, McCann RL. Impotence due to the pelvic steal syndrome: treatment by iliac transluminal angioplasty. J Urol. 1985. 133:860–861.

6. Kholoussy AM, Gain T, Matsumoto T. Impotence after aorto-iliac surgery: current concepts. Angiology. 1981. 32:589–594.

7. Castaneda-Zuniga WR, Smith A, Kaye K, Rusnak B, Herrerra M, Miller R, et al. Transluminal angioplasty for treatment of vasculogenic impotence. AJR Am J Roentgenol. 1982. 139:371–373.

8. Angelini P, Fighali S. Early experience with balloon angioplasty of internal iliac arteries for vasculogenic impotence. Cathet Cardiovasc Diagn. 1987. 13:107–110.

9. Van Unnik JG, Marsman JW. Impotence due to the external iliac steal syndrome treated by percutaneous transluminal angioplasty. J Urol. 1984. 131:544–545.

10. Karkos CD, Wood A, Bruce IA, Karkos PD, Baguneid MS, Lambert ME. Erectile dysfunction after open versus angioplasty aortoiliac procedures: a questionnaire survey. Vasc Endovascular Surg. 2004. 38:157–165.