Erectile dysfunction (ED) is defined as the inability to get and maintain a sufficient erection to ensure an acceptable sexual activity for the subject and the partner. Although ED does not represent per se a serious disease, it carries a notable and severe influence on quality of life, with significant implications on familiar and social relationship; DE may cause depression, shame, impairment of personal esteem and relational problems. Among many possible etiologies of ED, atherosclerotic disease of penile arteries represents one of the most frequent causes, so it should always be looked for in patients with multiple risk factors for cardiovascular disease or an established coronary or peripheral artery disease. Up to 75% of patients with ED have a stenosis of the iliac-pudendus-penile artery system, deputy to perfusion of male genital organ. Recently the potential treatment of this pathologic condition by percutaneous approach has emerged with valid angiographic results and with a significant improvement in symptoms and quality of life. This review focuses on the normal anatomy and physiology of erection, the pathophysiology of ED, the common points between ED and ischemic cardiomyopathy and, lastly, the new chance of endovascular intervention for ED, to give our cardiologist colleagues the opportunity to screen and adequately treat patients with vascular ED.