Correlación angiográfica, clínica de enfermedad coronaria obstructiva cardiaca y disfunción eréctil como diagnóstico silente
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Antecedentes: la cardiopatía isquémica manifestada con la obstrucción coronaria mayor del 70 %, acompañada de síntomas anginosos, va más allá de limitarse solo vasos epicárdicos sino también enfermedades periféricas como la disfunción eréctil con obstrucción de arterias pudendas >50 %; el abordaje multidisciplinario sin duda es clave para estratificar riesgo, prevenir potenciales complicaciones no solo funcionales sino pronósticas en el paciente por enfermedades cardiovasculares mayores.
Objetivo: correlacionar la enfermedad coronaria obstructiva por angiografía coronaria con presencia de disfunción eréctil clínica, angiográfica y funcional.
Métodos: se realizó coronariografía coronaria y posteriormente angiografía de arterias pudendas, donde se asoció la presencia de cardiopatía isquémica con lesiones del 70 % o lesiones de arterias pudendas >50 %.
Resultados: al cruzar la variable de enfermedad coronaria obstructiva y el grado de disfunción eréctil no se observa significancia estadística, los hombres con enfermedad coronaria presentan en porcentajes iguales grados de disfunción eréctil leve y graves (36 %) y en menor medida moderado (p>0.05).
Conclusiones: fue posible determinar el número de vasos afectados, entre más vasos afectados se presenten más probable es que exista disfunción eréctil y más probabilidad de estenosis de arteria pudendas.
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McCullough AR. The Penis as a Barometer of Endothelial Health. Reviews in Urology. 2003;5(Suppl 7): S3–S8.
Shabsigh R, Anastasiadis AG. Erectile dysfunction. Annual Review of Medicine. 2003;54: 153–168. https://doi.org/10.1146/annurev.med.54.101601.152212.
Bonetti PO, Lerman LO, Lerman A. Endothelial dysfunction: a marker of atherosclerotic risk. Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23(2): 168–175. https://doi.org/10.1161/01.atv.0000051384.43104.fc.
Andersson KE, Wagner G. Physiology of penile erection. Physiological Reviews. 1995;75(1): 191–236. https://doi.org/10.1152/physrev.1995.75.1.191.
Montorsi P, Ravagnani PM, Galli S, Rotatori F, Briganti A, Salonia A, et al. The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease. The American Journal of Cardiology. 2005;96(12B): 19M-23M. https://doi.org/10.1016/j.amjcard.2005.07.006.
McVary KT. Clinical practice. Erectile dysfunction. The New England Journal of Medicine. 2007;357(24): 2472–2481. https://doi.org/10.1056/NEJMcp067261.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. The Journal of Urology. 1994;151(1): 54–61. https://doi.org/10.1016/s0022-5347(17)34871-1.
Hodges LD, Kirby M, Solanki J, O’Donnell J, Brodie DA. The temporal relationship between erectile dysfunction and cardiovascular disease. International Journal of Clinical Practice. 2007;61(12): 2019–2025. https://doi.org/10.1111/j.1742-1241.2007.01629.x.
Park HW, Her SH, Park BH, Han DS, Yuk SM, Kim DW, et al. Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease. PLOS ONE. 2019;14(11): e0225179. https://doi.org/10.1371/journal.pone.0225179.
Rogers JH, Karimi H, Kao J, Link D, Javidan J, Yamasaki DS, et al. Internal pudendal artery stenoses and erectile dysfunction: correlation with angiographic coronary artery disease. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions. 2010;76(6): 882–887. https://doi.org/10.1002/ccd.22646.
Schouten BWV, Bohnen AM, Bosch JLHR, Bernsen RMD, Deckers JW, Dohle GR, et al. Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen Study. International Journal of Impotence Research. 2008;20(1): 92–99. https://doi.org/10.1038/sj.ijir.3901604.
Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. The Urologic Clinics of North America. 2005;32(4): 379–395, v. https://doi.org/10.1016/j.ucl.2005.08.007.
El-Sakka AI, Morsy AM, Fagih BI, Nassar AH. Coronary artery risk factors in patients with erectile dysfunction. The Journal of Urology. 2004;172(1): 251–254. https://doi.org/10.1097/01.ju.0000128572.31000.f0.
Wang TD, Lee WJ, Yang SC, Lin PC, Tai HC, Liu SP, et al. Clinical and Imaging Outcomes up to 1 Year Following Balloon Angioplasty for Isolated Penile Artery Stenoses in Patients With Erectile Dysfunction: The PERFECT-2 Study. Journal of Endovascular Therapy: An Official Journal of the International Society of Endovascular Specialists. 2016;23(6): 867–877. https://doi.org/10.1177/1526602816669337.
Khanna NN, Rao S. Pudendal artery stenting for male erectile dysfunction. Journal of Indian College of Cardiology. 2017;7: S61–S63. https://doi.org/10.1016/j.jicc.2017.06.012.
Jackson G, Rosen RC, Kloner RA, Kostis JB. The second Princeton consensus on sexual dysfunction and cardiac risk: new guidelines for sexual medicine. The Journal of Sexual Medicine. 2006;3(1): 28–36; discussion 36. https://doi.org/10.1111/j.1743-6109.2005.00196.x.
Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL, et al. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). The American Journal of Cardiology. 2005;96(2): 313–321. https://doi.org/10.1016/j.amjcard.2005.03.065.
Billups KL, Bank AJ, Padma-Nathan H, Katz SD, Williams RA. Erectile dysfunction as a harbinger for increased cardiometabolic risk. International Journal of Impotence Research. 2008;20(3): 236–242. https://doi.org/10.1038/sj.ijir.3901634.
Ucar G, Secil M, Demir O, Demir T, Comlekci A, Uysal S, et al. The combined use of brachial artery flow-mediated dilatation and carotid artery intima-media thickness measurements may be a method to determine vasculogenic erectile dysfunction. International Journal of Impotence Research. 2007;19(6): 577–583. https://doi.org/10.1038/sj.ijir.3901572.
Shishehbor MH, Philip F. Endovascular treatment for erectile dysfunction: an old paradigm revisited. Journal of the American College of Cardiology. 2012;60(25): 2628–2630. https://doi.org/10.1016/j.jacc.2012.09.032.
Diehm N, Do DD, Keo HH, Boerlin J, Regli C, Schumacher M, et al. Early Recoil After Balloon Angioplasty of Erection-Related Arteries in Patients With Arteriogenic Erectile Dysfunction. Journal of Endovascular Therapy: An Official Journal of the International Society of Endovascular Specialists. 2018;25(6): 710–715. https://doi.org/10.1177/1526602818807704.
Wang TD. Commentary: Angioplasty of Internal Pudendal and Penile Arteries for Arteriogenic Erectile Dysfunction: Reassuring, but the Jury Is Still Out. Journal of Endovascular Therapy: An Official Journal of the International Society of Endovascular Specialists. 2018;25(6): 716–718. https://doi.
org/10.1177/1526602818807774.