Inferior epigastric artery and penile deep dorsal vein 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: penile head dermatitis Indication 1. Penile arteriosclerosis or arteritis. 2. Deep venous leakage of the penis. Contraindications 1. Deep penile vein embolization of the penis. 2. The corpus cavernosum fibrosis. 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 The surgical procedure of this operation is basically the same as that of "abdominal inferior epigastric artery and penile dorsal artery anastomosis". After exposing and freeing the inferior epigastric artery and deep penile vein, the ligation of the penis root is performed at the proximal end of the penis, and heparin is used. Peritoneal saline was perfused into the distal end of the heart, and then the inferior epigastric artery was anastomosed to the distal end of the deep vein of the penis. Care should be taken to protect the dorsal artery and nerves next to the deep veins of the penis to avoid injury. Successful anastomosis should be seen in the deep veins of the back with obvious pulsations. After 5 minutes of open circulation, check for blood leakage, distortion, and excessive congestion of the penis head. Generally, the circumference of the penis head is increased by 2.5 to 3 cm. The incision was sutured layer by layer. complication The lack of anastomosis is the main complication. Once found, effective measures should be taken in time.

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