It’s estimated that more than 50 percent of men between 40 and 70 years old experience moderate to severe erectile dysfunction (ED). While ED has many causes, one of the most common is peripheral arterial disease (PAD), in which pelvic blood vessels become narrowed due to atherosclerosis.
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Most of us associate atherosclerosis, or the build-up of fat and cholesterol deposits called plaque, with coronary (or heart) arteries. However, atherosclerosis also can occur in blood vessels outside your heart, including the arteries that supply blood to the pelvic organs. Cleveland Clinic cardiologist Mehdi Shishehbor, DO, MPH, estimates that 70 percent of men with ED may have some form of atherosclerosis.
The ZEN study
A small, recently published safety and feasibility study looked at whether drug-coated arterial stents—similar to those placed during angioplasty in people with blood vessel blockages in the heart—can be used to treat ED. This endovascular intervention is focused on using a stent, which is a tiny metal scaffold, to open up a blood vessel called the internal pudendal artery to increase blood flow to the penis during arousal. The study focused specifically on the 50 percent of men with ED who weren’t helped by drugs called phosphodiesterase-5 inhibitors, such as Viagra®, Cialis® or Levitra®.
The promising results
Thirty men underwent the procedure, which resulted in both self-reported and clinical improvements in measures of erectile function. None of the men experienced any negative effects.
“This study presents the first major step in the application of endovascular intervention and provides several insights for the potential treatment of ED,” Dr. Shishehbor and his colleagues wrote in an editorial that accompanied the article.
However, they pointed out several limitations to the study, including the fact that fewer than 8 percent of the 383 patients originally screened were candidates for the intervention, which highlights the need for appropriate patient selection.
Stents may not be for everyone
In general, patients who could be helped by the procedure had small, rather than widespread, areas in the stented artery that were causing their ED.
“Therefore, stents alone may not be the best answer for all patients,” Dr. Shishehbor wrote. In addition, because of wide patient variations in the anatomy of the stented artery, it’s important that the intervention be done by a skilled operator, they emphasized.
Advice for men with ED
Major controlled clinical trials are needed to determine if this treatment could have a widespread clinical application. In the meantime, if you are a man who is experiencing ED, remember that this is not a condition that is a normal part of aging—it may be a symptom of an underlying condition. Be sure to talk to your internist and seek a referral to a urologist or vascular specialist that specializes in ED treatment.
Most importantly, keep in mind that ED caused by PAD could signal underlying cardiovascular problems. It’s important to work closely with your internist—and, as needed, a cardiologist—so that these problems can be diagnosed and treated early to decrease your risk of a major cardiovascular event.