Disfunção sexual após correção aberta de aneurisma da aorta abdominal: 16 anos de experiência em um centro quaternário e revisão da literatura

Schmid, Bruno Pagnin; Muce, Marcelo Vezzi; Bocos, Rodrigo Gonzalez; Menezes, Fábio Hüsemann

Bruno Pagnin Schmid

conception and design

analysis and interpretation

data collection

writing the article

critical revision of the article

statistical analysis

read and approved of the final version of the article

Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.

Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil.

https://orcid.org/0000-0002-2297-504X

Marcelo Vezzi Muce

conception and design

data collection

read and approved of the final version of the article

Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.

Rodrigo Gonzalez Bocos

writing the article

read and approved of the final version of the article

Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.

Fábio Hüsemann Menezes

conception and design

analysis and interpretation

critical revision of the article

final approval of the article

statistical analysis

overall responsibility

read and approved of the final version of the article

Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.

https://orcid.org/0000-0002-7747-308X

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Ethics committee approval: This study was approved by the Institutional Ethics Committee (CAAE 0984.0.146.000-11, decision number 1085/2011).

Correspondence Bruno Pagnin Schmid Rua Dr. José Romeiro Pereira, 57 - Alto de Pinheiros CEP 05446-060 - São Paulo (SP), Brasil Tel.: +55 (19) 3521-7175 / +55 (11) 94988-7000 E-mail: brunopschmid@gmail.com

Author information BPS - Vascular and endovascular surgeon, Universidade Estadual de Campinas (UNICAMP); Interventional radiologist, Hospital Israelita Albert Einstein (HIAE). MVM - MD, Universidade Estadual de Campinas (UNICAMP). RGB - Urologist, Universidade Estadual de Campinas (UNICAMP). FHM - Vascular and endovascular surgeon; Associate professor and assistant physician, Department of Surgery, Division of Vascular Surgery; PhD in Surgery, Universidade Estadual de Campinas (UNICAMP).

*
All authors have read and approved of the final version of the article submitted to J Vasc Bras.

Questions from the International Index of Erectile Function
1. How often were you able to get an erection during sexual activity?
2. When you attempted sexual intercourse, how often were you able to penetrate (enter) your partner?
3. During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?
4. How much have you enjoyed sexual intercourse?
5. When you had sexual stimulation or intercourse, how often did you ejaculate?
6. How satisfied have you been with your overall sex life?

	No sexual activity (Total = 21)	Normal activity (Total = 34)	ED (Total = 18)	RE (Total = 27)
Aorto-aortic (Total=26)/ percentage of group	4/ 15.4%	7/ 30%	2/ 7.7%	13/ 50%
Aorto-biiliac (Total=50)/ percentage of group	12/ 24%	21/ 42%	6/ 12%	11/ 22%
Aorto-monoiliac (Total=14)/ percentage of group	2/ 14.3%	6/ 42.86%	5/ 35.71%	1/ 7.14%
Aorto-bifemoral (Total=10)/ percentage of group	3/ 30%	0/ 0%	5/ 50%	2/ 20%

Sexual status	Age in years (mean)	No sexual activity vs. other groups (mean age/number of patients)	p-value ^* * Student’s t test.
No activity (Total = 21)	72.3	72.3 years (21 patients)	< 0.001
Normal activity (Total = 34)	63.9	64.5 years (79 patients)
ED (Total = 18)	63.7
RE (Total = 27)	65.8

Author	Study Design	Number of patients/studies	Main results
Kalteis et al.¹⁷17 Kalteis M, Gangl O, Huber F, Adelsgruber P, Kastner M, Lugmayr H. Clinical impact of hypogastric artery occlusion in endovascular aneurysm repair. Vascular. 2015;23(6):575-9. http://dx.doi.org/10.1177/1708538114560462. PMid:25414170. http://dx.doi.org/10.1177/17085381145604...	Retrospective	106 (82 EVAR vs. 24 EVAR with IIA embolization)	EVAR with IIA embolization was associated with new onset ED (17.3% vs. 42.9%; p = 0.043).
	Single-center
	EVAR vs. EVAR with IIA embolization
Majd et al.¹⁸18 Majd P, Ahmad W, Luebke T, Gawenda M, Brunkwall J. Impairment of erectile function after elective repair of abdominal aortic aneurysm. Vascular. 2016;24(1):37-43. http://dx.doi.org/10.1177/1708538115577290. PMid:25761855. http://dx.doi.org/10.1177/17085381155772...	Prospective	100 (70 EVAR vs 30 OR)	Increase of ED in both groups (53.3.% OR vs. 58.8% EVAR, p = 0.412).
	Single-center
	OR vs. EVAR
Machado et al.¹⁹19 Machado R, Teixeira G, Oliveira P, Loureiro L, Pereira C, Almeida R. Is age a determinant factor in EVAR as a predictor of outcomes or in the selection procedure? Our experience. Rev Bras Cir Cardiovasc. 2016;31(2):132-9. http://dx.doi.org/10.5935/1678-9741.20160037. PMid:27556312. http://dx.doi.org/10.5935/1678-9741.2016...	Retrospective	171	ED was more frequent in the elderly group (p<0.05)
	Single-center
	EVAR (patients were divided according to age groups < 70, 70-80, and > 80 years)
Shin et al.²⁰20 Shin SH, Starnes BW. Bifurcated-bifurcated aneurysm repair is a novel technique to repair infrarenal aortic aneurysms in the setting of iliac aneurysms. J Vasc Surg. 2017;66(5):1398-405. http://dx.doi.org/10.1016/j.jvs.2017.02.044. PMid:28502552. http://dx.doi.org/10.1016/j.jvs.2017.02....	Retrospective	14	No cases of ED
	Single-center
	EVAR (bifurcated-bifurcated repair)
Bosanquet et al.²¹21 Bosanquet DC, Wilcox C, Whitehurst L, et al. Systematic review and meta-analysis of the effect of internal iliac artery exclusion for patients undergoing EVAR. Eur J Vasc Endovasc Surg. 2017;53(4):534-48. http://dx.doi.org/10.1016/j.ejvs.2017.01.009. PMid:28242154. http://dx.doi.org/10.1016/j.ejvs.2017.01...	Meta-analysis	2671	Higher rates of ED after coiling (11.6% Coils vs. 3.03% Plugs)
	EVAR (coils vs. plugs)	2671
Regnier et al.²²22 Regnier P, Lareyre F, Hassen-Khodja R, Durand M, Touma J, Raffort J. Sexual dysfunction after abdominal aortic aneurysm surgical repair: current knowledge and future directions. Eur J Vasc Endovasc Surg. 2018;55(2):267-80. http://dx.doi.org/10.1016/j.ejvs.2017.11.028. PMid:29292207. http://dx.doi.org/10.1016/j.ejvs.2017.11...	Meta-analysis	29 studies	Post-operative ED prevalence= (OR 7.4 to 79% vs. EVAR 4.7 to 82%). Post-operative RE prevalence= (OR 3.3 to 9% vs. Laparoscopic repair 6 to 6.6%)
Kudo et al.²³23 Kudo T. Surgical complications after open abdominal aortic aneurysm repair: intestinal ischemia, buttock claudication and sexual dysfunction. Ann Vasc Dis. 2019;12(2):157-62. http://dx.doi.org/10.3400/avd.ra.19-00038. PMid:31275467. http://dx.doi.org/10.3400/avd.ra.19-0003...	Narrative Review	NR	Emphasized the importance of preservation of blood flow from IIA and of adequate preservation of the superior hypogastric plexus and lumbar splanchnic nerves
Gallitto et al.¹⁶16 Gallitto E, Faggioli G, Mascoli C, et al. Long-term efficacy of evar in patients aged less than 65 years with an infrarenal abdominal aortic aneurysm and favorable anatomy. Ann Vasc Surg. 2020;67:283-92. http://dx.doi.org/10.1016/j.avsg.2020.03.038. PMid:32283305. http://dx.doi.org/10.1016/j.avsg.2020.03...	Retrospective	115 (58 EVAR, 57 OR)	RE occurred more often in OR patients (31%) than in EVAR patients (2%) (P = 0.001).
	Single-center
	EVAR vs. OR
van Schaik et al.²⁴24 van Schaik J, van der Vorst JR, Hamming JF, Elzevier HW, Nicolai MPJ. Vascular surgeons’ views on ejaculation disorders after abdominal aortic surgery: results of a dutch survey. Ann Vasc Surg. 2020;67:346-53. http://dx.doi.org/10.1016/j.avsg.2020.02.021. PMid:32247063. http://dx.doi.org/10.1016/j.avsg.2020.02...	A questionnaire-based study aiming to analyze care for sexual health by medical specialists	101	A gap exists in knowledge of pathophysiology and anatomy. Vascular surgeons lack sexual counseling skills
Dariane et al.²⁵25 Dariane C, Javerliat I, Doizi S, et al. Sexual dysfunction after elective laparoscopic or endovascular abdominal aortic aneurysm repair in men. Prog Urol. 2020;30(2):105-13. http://dx.doi.org/10.1016/j.purol.2019.12.003. PMid:31959570. http://dx.doi.org/10.1016/j.purol.2019.1...	Prospective. Multicenter.	25 (8 EVAR/ 13 Laparoscopic repair)	RE is frequent in both groups (Laparoscopic=61.5%/ EVAR=12.5%) Laparoscopic AAA repair caused no onset of ED or SD
	EVAR vs. Laparoscopic repair	25 (8 EVAR/ 13 Laparoscopic repair)
Schmid et al. (This study)	Retrospective	100	The aorto-bifemoral configuration was the technique most associated with ED (p=0.03) and the aorto-aortic configuration was the technique most associated with RE (p= 0.01). OR is associated with 64% of SD, 24% of RE, 18% of ED, and 21% of no sexual activity
	Single-center
	OR (aorto-bifemoral bypass vs. Aorto-aortic vs. aorto-biiliac vs. aorto-monoiliac)

[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

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Disfunção sexual após correção aberta de aneurisma da aorta abdominal: 16 anos de experiência em um centro quaternário e revisão da literatura

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