Microsurgical arterialization for vascular impotence

Of 400 patients with erectile lesions Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phallo-arteriography in 22 males demonstrated occlusion of the internal pudendal artery in 21 of them. In 15 patients penile arterialization was done by interposition of a saphenous vein graft between the iliac artery and deep dorsal penile vein. In 4 of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively two thirds of the patients are doing well. Failures in 5 of them included 4 diabetic neurovascular lesions and 1 postoperative priapism.     

Venous arterialization for erectile impotence

Revascularization of the corporal bodies in arteriogenic impotence can be accomplished by means of a venous arterialization procedure as described by Ronald Virag. This surgical approach and early results are detailed in this article.     

Microsurgical arterialization for vascular impotence

Out of 400 patients with erectile lesions, Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phalloarteriography in 22 males demonstrated an occlusion of the interna pudendal artery in 21. In 15 patients penile arterialization was done by interposition of a saphenous vein-graft between the iliac artery and the deep dorsal penile vein. In four of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively, two of three of the patients are doing well. Failures in five included four diabetic neurovascular lesions and one postoperative priapism.     

Cavernous vein arterialization for vasculogenic impotence: An animal model

We designed acute and chronic animal models to evaluate a new procedure of arterialization of the cavernous vein. In the acute study, arteriogenic impotence was induced in 6 dogs by bilateral ligation of the penile arteries just proximal to the crus of the penis. The cavernous vein and penile artery were anastomosed proximal to the site of ligation, and the pudendal vein was ligated proximally to prevent the diversion of arterial blood away from the penis. Erection was induced either by electrostimulation of the cavernous nerves or by intracavernous injection of papaverine, and the erectile response was studied before and after cavernous vein arterialization. Four dogs were followed up for two months to evaluate the long-term effects of the procedure. Shortly after arterialization of the cavernous vein, the basal flow rate in the internal pudendal artery increased dramatically to almost six times the control rate, and the erectile response to neurostimulation was approximately 85 percent of control. Selective pudendal arteriography at two months confirmed the patency of all arteriovenous anastomoses. However, scanning electron microscopy and histologic examination revealed sinusoidal damage most probably consequent to the chronically elevated arterial flow.     

Penile venous surgery for cavernovenous impotence

Summary Cavernovenous leakage represents an important cause of erectile dysfunction. It is treated by ligatureresection of the different venous pathways, but this surgical approach is certainly not the best method to obtain long-term good results. The operative techniques, are discussed in the light of results reported in the literature.     

High-flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogenic impotence.

Microsurgical penile revascularization is becoming an increasingly applied technique in patients with arteriogenic or mixed arteriogenic and venogenic impotence. Deep dorsal vein arterialization has been used successfully in selected patients. Aside from failure of the procedure and the occasional problems associated with vascular surgery, priapism and glans hypervascularization are specific complications of deep dorsal vein arterialization. Priapism in these cases is 'high-flow'; the functional arterial-cavernous fistula can overcome the maintenance of the flaccid state and cause persistent erection. Glans hypervascularization, a syndrome of glans enlargement, skin changes and pain secondary to excessive retrograde filling of the glans penis and corpus spongiosum, can result in urethral compression and glans ulceration. Along with the presentation of the case of a man who suffered both complications, we discuss their pathophysiology, prevention, and treatment.     

Distal venous arterialization for limb salvage--a case report

The reperfusion of an ischemic limb in the absence of suitable target artery remains a formidable task. The authors report a case of an ischemic limb in patient whose distal arteries were identified intraoperatively as unsuitable for conventional revascularization. A distal arteriovenous fistula was created between the already arterialized in situ greater saphenous vein conduit and the inframalleolar superficial venous system of the foot. The flow through the superficial venous system salvaged the limb and continues to perfuse the foot 4 years post-operatively with resolution of rest pain.     

Selective arterialization of the coronary venous system

The idea of myocardial revascularization by means of grafting the coronary venous system is more than a century old; in cases of diffuse coronary artery disease, this may represent a valid therapeutic option. We present a challenging case in which a patient with an aberrant left coronary system and unstable angina underwent this type of procedure with good clinical results.     

Percutaneous transpenile and retrograde venous occlusion for the treatment of venous leak impotence

In 17 patients percutaneous transpenile venous occlusion was performed for the treatment of so-called venous leak impotence. Because of primary failure, the procedure was repeated in 5 patients. On four occasions, it was combined with a retrograde venous occlusion via the internal iliac vein. Within a rather short follow-up period of 23 months maximum, the overall success rate is 65%. Six patients are able to have intercourse and 5 others need additional intracavernous injections. Complications of the procedure were not observed.     

Initial experience with dorsal venous arch arterialization for limb salvage

Surgical reconstruction for patients with symptomatic lower extremity arterial occlusive disease is successful when a suitable distal target vessel is present. In patients with unreconstructable disease, practical surgical options are at a minimum. We report our initial experience with dorsal venous arch arterialization (DVAA) for limb salvage. Patients with a lower extremity arteriogram and tibia/plantar artery duplex scan demonstrating unreconstructable occlusive disease were evaluated for DVAA. The venous arch valve lysis technique consisted of retrograde balloon catheter, arterial dilator disruption, and direct valvulectomy. Outcome variables included patency, limb salvage rate, and toe pressure alterations. Initial results suggest that DVAA may be a viable option for end-stage limb salvage. Application of the DVAA appears to be more suitable for patients with symptoms secondary to atherosclerosis than those with Buerger's disease.     

手指皮肤脱套伤静脉动脉化修复的临床应用

目的探讨无指固有动脉存留的手指皮肤脱套伤静脉动脉化修复的临床效果。方法在脱套手指皮肤侧方纵行切开．摊开皮肤呈一块状游离皮瓣,找到两条主干静脉,标识。在10倍手术显微镜下,先将皮瓣脂肪大部分清除,保留皮瓣的真皮下血管网,再显露并切断两条主干静脉之间的交通支,脱套手指皮肤原位回植,皮肤的一条静脉远端或近端与伤指的指固有动脉吻合,另一端结扎;另一条静脉近端与指背静脉吻合．临床应用5例。结果本组5例术后0．5～3h皮肤出现毛细血管反应,4-6h变红润,之后未出现皮色暗紫、严重肿胀。其中2例顺利成活;2例术后3d有皮肤肿胀、瘀血明显,经远端小切口放血3～5d后好转并全部成活：1例部分坏死．经换药后植皮愈合。成活的皮肤随访3个月～1年,皮肤质地柔软,弹性、耐磨性好,色泽稍暗,皮肤两点辨别觉4～10mm。结论静脉动脉化修复无指固有动脉存留的手指皮肤脱套伤临床效果良好。     

Vasculogenic impotence. Arterial and venous surgery

Arterial revascularization and venous ligation procedures have been introduced within the past 2 decades. Each procedure has in common with the other the fact that initial applications of the operations were widespread among the population of men with vasculogenic erectile dysfunction. In each case, disappointing long-term results led to more limited use of surgery targeting specific groups that clearly would benefit from the procedures. The wider application of these procedures in vasculogenic erectile dysfunction is not supported by the available results. The Clinical Guidelines Panel of the American Urological Association supported this view in 1996 after a meta-analysis of literature reports and declared that venous and arterial surgery was not justified in routine use, especially in patients with arteriosclerosis. Further studies are likely to refine patient selection but are unlikely to expand the therapeutic use of these procedures.     

Male impotence. Radiologic venous evaluation

Vascular lesions are one of the most frequent causes of organic impotence. Dysfunction of the penile veno-occlusive mechanism is studied by cavernography-cavernometry. The major criterion of venous leakage is the maintenance flow which remains less than 25 ml/min after intracavernous injection of papaverine (60 mg). In the erect state cavernography can demonstrate the abnormal venous drainage.     

A novel approach: ascending venous arterialization for atherosclerosis obliterans.

OBJECTIVE: Lower limb arterial occlusion with no patent distal artery suitable for revascularisation is a common problem. The aim of this study was to assess the role of revascularisation to distal veins (ascending venous arterialization) in patients not reconstructable by conventional bypass. METHOD: Ascending venous arterialization is a distal arteriovenous fistula. Reversed great saphenous vein grafts, from above the knee, were anastomosed to the common femoral artery, superficial femoral artery or popliteal artery and distally to the saphenous vein at the level of medial malleolus. No intervention was done to destroy the venous valves. The great saphenous vein was ligated below the knee. In this way, oxygenated blood could reach to dorsal venous arch and the tissues below the knee in an ascending fashion through the great saphenous vein, which was not removed. RESULTS: All of the patients recovered immediately after the operation. The lesions on the feet and on the toes of the patients improved in a short time. Intermittent claudication of the patients disappeared. Strong pulses were detected on the dorsal venous arch with manual Doppler in 3 weeks. The below knee tissues were perfused with the applied technique. CONCLUSION: Ascending venous arterialization can be applied for limb salvage to the patients who do not have a suitable arterial bed to revascularize with conventional techniques.     

Replantation of completely amputated thumbs with venous arterialization

PURPOSE: To report a new method of replanting completely amputated thumbs with venous arterialization. METHODS: In 6 replantation surgeries of completely amputated thumbs performed during the period 1999-2003, the proximal artery was anastomosed with a vein of the amputated part to establish inflow and the proximal vein was anastomosed with several other veins in the amputated part to establish outflow. This was because the proper palmar digital arteries were seriously injured or anastomosis of proper palmar digital arteries failed many times. RESULTS: All the replanted thumbs survived, regained good sensory and motor functions, and showed no difference from thumbs replanted conventionally. CONCLUSIONS: Venous arterialization may salvage otherwise unreplantable thumbs.     

海绵体测压结合造影诊断静脉漏性阳萎的体会(附58例报告)

为了提高阳萎诊治水平，应用阴茎海绵体血流测量仪结合海绵体造影检查５８例阳萎病人，其中２６例被明确诊断为静脉漏性阳萎，确定静脉漏的程度并指出所在部位，为进一步治疗包括手术提供有力依据。     

False diagnoses of venous leak impotence.

Tests for erectile dysfunction using intracavernous injections of vasoactive drugs are currently popular and have resulted in frequent diagnoses of venous leak impotence. Tests used to make this diagnosis, however, have not been validated by study in control subjects. We present 2 cases of false diagnoses of venous leak impotence. Anxiety mediated through the sympathetic nervous system may block the action of intracavernous smooth muscle relaxants. The resulting incidence of false diagnoses of venous leak impotence is unknown.     

门静脉动脉化在肝移植中的应用

用动脉血代替门静脉血灌注肝脏的设想最初是由Cohn( 1 95 2年 )和Fisher( 1 95 4年 )根据门静脉高压门腔分流术后肝脏血液灌注减少 ,术后肝性脑病发生率高而提出的[1 ,2 ] 。随后许多学者作了大量动物实验研究 ,证实用适当流量和压力的动脉血灌注肝内门静脉时 ,动物在分流术后可维持正常的肝血流量、血氨和血胆酸水平 ,保证肝脏的正常解毒功能 ,肝细胞形态保持不变。自从 1 960年以来 ,门静脉动脉化 (APV)的概念由于它的各种临床应用已经引起广泛的关注 ,在行端侧吻合门体分流治疗肝硬化的过程中 ,APV首先被临床应用去降低分流术后肝性…     

Distal venous arterialization and reperfusion injury: focus on oxidative status

In patients with unreconstructable arterial occlusive disease distal venous arterialization (DVA) seems to be a promising option in the treatment. The goals of this prospective study were to assess clinical efficiency and possible impact of DVA on tissue damage by estimating oxidative status of patients with critical limb ischemia treated with this procedure. The subjects were 60 randomized patients: 30 were undergoing DVA and 30 were treated with antiaggregation therapy. During the mean follow-up period (6.13 ± 4.32 months for DVA vs. 6.74 ± 0.5 months for antiaggregation therapy) survival (p < 0.01), limb salvage (p < 0.001), pain relief (p < 0.001) and wound healing (p < 0.001) rates were significantly different between the two groups of patients in favor of the DVA group. Ten minutes after declamping we observed a decreasing trend in the lactate level in the blood of the deep venous system (p < 0.001). Also, on postoperative day 7 digital systolic pressure and digital-brachial index were higher than before the operation (p < 0.001). In blood samples collected immediately before and successively at 1, 3, 5 and 10 min postoperatively, prooxidative status (thiobarbituric acid reactive substances, O(2)(-), H(2)O(2) and nitric oxide) and antioxidative enzymes (superoxide dismutase, catalase and glutathione reductase) were determined spectrophotometrically. Using the nonparametric Friedman test, we noted statistically nonsignificant differences (p > 0.05) in values of both prooxidative parameters and enzymes of the antioxidative defense system, before and successively at 1, 3, 5 and 10 min after operation. These results indicate that there was no statistically significant reperfusion injury after revascularization, which could have been expected after this surgical procedure, thus confirming its validity in these patients.