Penile revascularization using the descending branch of the lateral circumflex femoral artery: An alternative vascular graft

Vittorio Ramella; Giovanni Papa; Federico Zorzi; Michele Rizzo; Tommaso Cai; Giovanni Liguori

doi:10.1016/j.ijscr.2023.108939

Penile revascularization using the descending branch of the lateral circumflex femoral artery: An alternative vascular graft

Int J Surg Case Rep. 2023 Nov:112:108939. doi: 10.1016/j.ijscr.2023.108939. Epub 2023 Oct 17.

Authors

Vittorio Ramella¹, Giovanni Papa¹, Federico Zorzi², Michele Rizzo², Tommaso Cai³, Giovanni Liguori⁴

Affiliations

¹ Department of Medical, Surgical and Health Sciences, Plastic, Reconstructive and Aesthetic Surgery Unit, University of Trieste, Trieste, Italy.
² Department of Medical, Surgical and Health Sciences, Urology Unit, University of Trieste, Trieste, Italy.
³ Department of Urology, Santa Chiara Hospital, Trento, Italy.
⁴ Department of Medical, Surgical and Health Sciences, Urology Unit, University of Trieste, Trieste, Italy. Electronic address: gliguori@units.it.

Abstract

Introduction and relevance: Microsurgical revascularization stands as the preferred method for addressing erectile dysfunction (ED) resulting from traumatic penile arterial insufficiency. Traditional microarterial bypass surgery (MABS) techniques have typically relied on utilizing the inferior epigastric artery (IEA) as the graft vessel. However, issues such as endothelial dysfunction in the vessel and alterations in abdominal tissue can negatively impact surgical outcomes. MABS using the descending branch of the lateral circumflex artery of the femur (DLCFA) should be proposed as a surgical option for penile arterial revascularization.

Case presentation: A 29-year-old who experienced ED after a pelvic bone fracture with hypogastric vascular injury was referred to our center. Preoperatory penile Doppler ultrasound (PDU) examination documented the presence of arterial insufficiency. Selective hypogastric angiography pointed out the interruption of arterial blood flow at the level of the distal right internal pudendal artery.

Case discussion: Access to the dorsal penile artery was gained through an infrapubic incision, the DLCFA pedicle was isolated through an incision along the anterolateral right thigh. After its transposition, the arterial bundle was anastomosed to the dorsal penile artery in an end-to-end fashion. Intraoperative PDU has been used to verify the patency of the anastomosis. At 6 months follow-up, optimal flow parameters on PDU were persistently registered, and the patient had consistent clinical improvement on the IIEF-5 score.

Conclusion: DLCFA grafting for penile revascularization is a suitable therapeutic option in traumatic ED due to its size and accessibility. Further experience is necessary to compare clinical outcomes among different revascularization techniques.

Keywords: Case report; Erectile dysfunction; IIEF; Penile revascularization; Trauma.

Publication types

Case Reports