Inferior epigastric artery and dorsal penile artery anastomosis

Congenital dysplasia, trauma, and arteriosclerosis of the penile artery and its source branches (internal iliac artery, internal pudendal artery) and collaterals (deep penile artery, dorsal artery) can cause erectile dysfunction. Arterial angiography was performed on patients with ED. It was found that pathological changes such as stenosis, atresia or dysplasia accounted for 25% to 85.5% of the above-mentioned arteries, and the incidence of arterial ED was higher than expected. There are many methods for the diagnosis of arterial ED. Clinically, there are penile blood pressure measurement and arteriography. Arterial angiography can determine the location, extent, and extent of the lesion, providing a reliable and objective basis for surgical treatment. Insufficient blood supply to the penis can be divided into two categories according to anatomy: 1 Insufficient blood supply to the proximal vessel: it includes lesions in the main-iliac artery, and the pathological changes are mainly arteritis, atheromatous plaque blocked at the level of the main-iliac artery and sputum The end of the internal artery. 2 distal arterial insufficiency: its scope includes the internal iliac artery, the internal pudendal artery and its branches. The lesions are mainly atherosclerosis. Young women with pelvic fractures may also have damage to the internal pudendal artery and its branches. In patients with primary ED, the cavernous artery may not be developed or deformed. There are two types of surgical methods for arterial ED: vascular reconstruction and percutaneous transluminal angioplasty. For aortic bifurcation thrombosis, also known as Leriche syndrome, stenosis and intraorbital local stenosis or atresia, endarterectomy or bypass surgery may be used. Recently, percutaneous transluminal angioplasty has been used to treat short, smooth stenosis of the common or internal iliac artery, proximal pyloric artery, or short stenosis of the proximal end of the penile dorsal artery. After the improvement of blood supply, ED is expected to recover. However, the effect on long segmental stenosis is poor. A traumatic short segmental stenosis of the internal pudendal artery can also be performed with a resection of the anastomosis. For the distal vascular atresia of the penis, the inferior epigastric artery and the corpus cavernosum can be directly anastomosed, the inferior epigastric artery and the penile dorsal artery or the deep penile artery anastomosis, and the inferior epigastric artery and the penile dorsal deep vein anastomosis (vein arterialization). The efficacy of arterial anastomosis depends on the following factors: 1 whether the microsurgical technique is skilled; 2 whether the intracavernous venous pressure is normal; 3 the lighter the better; 4 the fewer the vascular risk factors, the better. Treatment of diseases: scrotum before the penis Indication Internal sinus arterial atresia or proximal penile artery atresia. Preoperative preparation 1. Angiography confirmed that the penile dorsal artery was normal and the inferior epigastric artery was normal. 2. Understand the presence or absence of vascular risk factors (diabetes, hypertension, hyperlipidemia, severe smoking). The more risk factors, the worse the efficacy. 3. Antibiotics were given 1 day before surgery. Surgical procedure 1. Abdominal incision: Incision in the medial incision of the left lower abdomen or incision of the lateral rectus abdominis, the upper umbilicus to the pubic symphysis, about 16cm long. 2. Exposing the inferior epigastric artery: incision of the skin, subcutaneous tissue, and rectus abdominis anterior sheath, pulling the rectus abdominis to the center, dissecting the inferior epigastric artery 16-20 cm at the lateral margin, carefully ligating the collaterals, accompanied by veins Ligation. The inferior epigastric artery was cut and the distal end was double-ligated with a 4 gauge wire. Immediately, the artery was perfused with 5 ml of 1 heparin saline, and clamped with a non-invasive vascular clamp for use. 3. Penis incision: a 3 cm straight incision in the dorsal root of the penis. Cut the skin and ligature the superficial vein. 4. Exposing the dorsal artery of the penis: Incision of the Buck fascia, in which the dorsal artery, vein and nerve of the penis are visible. There are two branches of the dorsal artery of the penis, which are not so large. The larger one is selected for separation, and the root is cut at the root, and the proximal end is double-ligated. 5. Transfer the inferior epigastric artery: The inferior epigastric artery was pulled through the inguinal subcutaneous tunnel to the dorsal incision of the penis, and the end of the penile dorsal artery was anastomosed with a 10-0 nylon thread. After the anastomosis is completed, the penile dorsal artery is obviously beaten, indicating that the anastomosis is successful. 6. The suture incision was examined without leakage of blood leakage. After confirming that the anastomosis was smooth, the penis and the inferior abdominal incision were sutured layer by layer. complication The lack of anastomosis is the main complication. Once found, effective measures should be taken in time.