Link Between Vasculogenic ED, CAD, and PAD
Link Between Vasculogenic ED, CAD, and PAD
The accumulation of evidence supporting ED as a predictor of CAD indicates the need for physicians to consider and recognize the former as a warning sign of more severe systemic disease. Along with an adequate medical history and physical examination, there are non-invasive diagnostic methods to assess ED. Similar to the ankle-brachial index for peripheral artery disease diagnosis, the penile-brachial index demonstrates the relationship between the brachial systolic arterial pressure and penile arterial pressure. While a penile to brachial pressure ratio of 1.0 is normal, a ratio of <0.6 is considered the threshold for diagnosis of vasculogenic ED; however, with only 70% accuracy, this test is not particularly sensitive or specific. Doppler ultrasound with intracavernosal vasodilator injection is another imaging modality that measures peak systolic flow velocity in the cavernosal arteries, considered the most accurate indicator of arterial disease, as well as cavernosal artery diameter, degree of arterial dilatation, and acceleration time. Doppler ultrasound can diagnose vascular pathology, including arterial insufficiency and veno-occlusive disease, with 93.8% sensitivity and 77% specificity. Furthermore, the dose required for erection after injection of the intracavernosal agent correlates with findings from Doppler ultrasound, cavernosography, and arteriography.
Non-invasive Evaluation of ED
The accumulation of evidence supporting ED as a predictor of CAD indicates the need for physicians to consider and recognize the former as a warning sign of more severe systemic disease. Along with an adequate medical history and physical examination, there are non-invasive diagnostic methods to assess ED. Similar to the ankle-brachial index for peripheral artery disease diagnosis, the penile-brachial index demonstrates the relationship between the brachial systolic arterial pressure and penile arterial pressure. While a penile to brachial pressure ratio of 1.0 is normal, a ratio of <0.6 is considered the threshold for diagnosis of vasculogenic ED; however, with only 70% accuracy, this test is not particularly sensitive or specific. Doppler ultrasound with intracavernosal vasodilator injection is another imaging modality that measures peak systolic flow velocity in the cavernosal arteries, considered the most accurate indicator of arterial disease, as well as cavernosal artery diameter, degree of arterial dilatation, and acceleration time. Doppler ultrasound can diagnose vascular pathology, including arterial insufficiency and veno-occlusive disease, with 93.8% sensitivity and 77% specificity. Furthermore, the dose required for erection after injection of the intracavernosal agent correlates with findings from Doppler ultrasound, cavernosography, and arteriography.
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