Can iliac artery stenosis cause erectile dysfunction (ED), testicular pain, and thigh pain?

Iliac Artery Stenosis and Its Relationship to Erectile Dysfunction, Testicular Pain, and Thigh Pain

Yes, iliac artery stenosis can cause erectile dysfunction (ED), testicular pain, and thigh pain due to compromised blood flow to the pelvic region and lower extremities. 1, 2

Pathophysiological Mechanism

Erectile Dysfunction

• Iliac artery stenosis restricts blood flow to the internal pudendal arteries, which are critical for penile erection 3
• The incidence of ED in patients with common iliac artery occlusion is approximately 74% 2
• Revascularization of iliac artery occlusions improves erectile function in about 61.5% of impotent patients 2

Testicular and Pelvic Pain

• Compromised blood flow to the testicles and pelvic organs can cause ischemic pain 4
• Pelvic ischemia from iliac artery stenosis can lead to lower urinary tract symptoms and sexual dysfunction 4
• Internal iliac artery (hypogastric artery) stenosis particularly affects blood flow to pelvic organs 1

Thigh Pain and Claudication

• Common iliac artery stenosis can cause thigh claudication and pain, especially during exertion 1
• Pain typically manifests in the buttock, hip, and thigh regions 1
• Symptoms worsen with activity and improve with rest, consistent with vascular claudication 1

Diagnostic Considerations

Key Diagnostic Tests

• Ankle-brachial index (ABI) is the first-line diagnostic test for peripheral artery disease 5
• CT angiography (CTA) or MR angiography (MRA) for detailed vascular imaging 1, 5
• Duplex ultrasound can identify stenosis or occlusion 5
• Digital subtraction angiography provides detailed visualization of the iliopudendal vascular tree 6, 3

Clinical Clues

• Erectile dysfunction that coincides with thigh/buttock claudication strongly suggests iliac artery disease 2
• Diminished femoral pulses may be present, though not always correlated with impotence 7
• Bilateral symptoms may indicate aortoiliac disease (Leriche syndrome) 4

Treatment Options

Endovascular Intervention

• Percutaneous transluminal angioplasty (PTA) with or without stenting is effective for iliac artery stenosis 6, 2
• Success rate for improving erectile function with PTA is approximately 65% 6
• Endovascular revascularization is the preferred first-line treatment for TASC A and B lesions 1
• Primary stenting has demonstrated significant benefits over angioplasty alone for more complex lesions 1

Surgical Options

• Open surgical revascularization may be necessary for extensive disease (TASC D lesions) 1
• When performing repairs, preservation of at least one hypogastric artery is recommended to decrease the risk of pelvic ischemia 1

Post-Treatment Outcomes

• Endovascular recanalization of common iliac artery occlusions improves sexual function in over half of patients with ED 2
• Significant improvements in erectile function, orgasm, and sexual desire are observed 6 months after revascularization 4
• PTA is repeatable with a low complication rate, making it valuable for patients with combined impotence and claudication 6

Important Considerations and Pitfalls

• Bilateral hypogastric artery occlusion should be avoided during treatment as it may result in buttock claudication, erectile dysfunction, and visceral ischemia 1
• Patients with iliac artery stenosis often have systemic atherosclerosis and increased risk of cardiovascular events 5
• Erectile dysfunction may be multifactorial, with both vascular and neurogenic components, especially in diabetic patients 7
• Internal pudendal artery stenosis correlates more strongly with impotence than iliac artery stenosis alone 7

In summary, iliac artery stenosis is a significant but treatable cause of erectile dysfunction, testicular pain, and thigh pain. Endovascular interventions offer effective treatment options with substantial improvement in symptoms and quality of life.