Internal iliac artery angioplasty for the treatment of buttock claudication and erectile dysfunction: a systematic review

Transcription

1 Internal iliac artery angioplasty for the treatment of buttock claudication and erectile dysfunction: a systematic review K Pate l 1, U Beschorner 2, P H o l t 1, K S r i t h aran 1 1 S t G e o r g e s Va s c u l a r I n s t i t u t e, S t G e o r g e s U n i v e r s i t y L o n d o n, U K 2 D e p a r t m e n t o f C a r d i o l o g y a n d A n g i o l o g y I I, U n i v e r s i t a e t s - H e r z z e n t r u m, F r e i b u r g - B a d K r o z i n g e n, G e r m a n y

2 Aims Investigate the role of angioplasty for the treatment of buttock claudication and erectile dysfunction in patients with proven lesions of the pelvic circulation Investigate the safety profile of angioplasty in these conditions To Synthesise the eligible data

3 Methods Review Methods were as the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines PubMed, EMBASE and CENTRAL databases were searched Exclusion Criteria Revascularisation following exclusion for AAA repair Open revascularisation

4 PUBMED 890 papers identified EMBASE 1089 papers identified CENTRAL 118 papers identified 2097 papers Title and abstract assessed and duplicates removed 2062 papers and duplicates excluded 4 papers identified from references of full texts and included 35 papers Full text assessed 39 papers Full text assessed 24 papers included in final analysis 15 papers excluded 6 Open revascularisation 3 Abstracts only 1 EIA stenting 1 Review 1 Internal iliac aneurysm 1 penile gangrene 1 Italian paper 1 Peripheral claudication

5 Results 24 studies eligible for analysis 124 patients treated for buttock claudication 59 patients treated for Erectile dysfunction Data extraction encompassed time period from

6 Buttock Claudication 124 patients 107 IIA lesions 74 treated with PTA 33 treated with PTA + stent 54 SGA lesions 36 treated with PTA 18 treated with PTA + stents Complete relief in 66% patients Partial relief in 21% patients No change in 13% Complete relief in 91% patients Partial relief in 2% patients No change in 7% patients

7 Restenosis rates Restenosis occurred in 9% of IIA patients 75% had further endovascular procedures 25% treated conservatively 100% had relief of symptoms Restenosis occurred in 31% of SGA patients 100% had further endovascular procedures 64% had relief of symptoms post re-intervention

8 Erectile dysfunction 59 patients 86 lesions of IIA, SGA and IPA treated 2 studies reported changes in IIEF changes 8 studies reported resolution of symptoms

9 Erectile dysfunction 2 papers reporting IIEF 39 patients 55 lesions treated with PTA alone 2 lesions treated with PTA + stent Conflicting results Von Allmen reported no change in IIEF Rogers reported 59.3% patients had improvement in IIEF >4 8 papers reporting resolution 18 patients 26 lesions treated with PTA alone 3 lesions treated with PTA + stent 50% had complete resolution of symptoms 6% had partial resolution of symtoms 44% had no change in symptoms

10 Complication rates Claudication population 4% complication rate 2 dissection of ipsilateral CIA 2 episodes of extravasation of contrast into buttocks 1 dissection of ipsilateral EIA Erectile dysfunction population 2% complication rate 1 Bleed requiring open repair of arteriotomy

11 Limitations Small studies Paucity of data Positive publications bias Inconsistent reporting

12 Conclusions Angioplasty for buttock claudication appears to be a an effective treatment in patients with proven IIA or SGA stenosis Angioplasty for erectile dysfunction remains controversial with varying effect size. Angioplasty appears to be safe in these selected patients

13 Internal iliac artery angioplasty for the treatment of buttock claudication and erectile dysfunction: a systematic review K Pate l 1, U Beschorner 2, P H o l t 1, K S r i t h aran 1 1 S t G e o r g e s Va s c u l a r I n s t i t u t e, S t G e o r g e s U n i v e r s i t y L o n d o n, U K 2 D e p a r t m e n t o f C a r d i o l o g y a n d A n g i o l o g y I I, U n i v e r s i t a e t s - H e r z z e n t r u m, F r e i b u r g - B a d K r o z i n g e n, G e r m a n y