Erectile Dysfunction — Vascular Causes

Key Facts at a Glance

Affects 50% of men over 50
Organic (often vascular) cause in up to 80% of cases

Vascular erectile dysfunction

Erectile dysfunction (ED) affects 50% of men over 50. In up to 80% of cases, an organic cause — often vascular — underlies the problem. Two main vascular mechanisms are recognised: insufficient arterial inflow (arteriogenic) and excessive venous drainage (venous leak or venoocclusive dysfunction).

At Cochin AP-HP, we specialise in the diagnosis and treatment of venous leak erectile dysfunction, confirmed by cavernosography (dynamic CT after intracavernosal injection), and treated by percutaneous embolization of the abnormal draining veins — without surgery.

Diagnostic workup

🔬 Penile duplex Doppler

First-line investigation. After intracavernosal prostaglandin E1 injection: peak systolic velocity (PSV) >35 cm/s = normal arterial flow. End-diastolic velocity (EDV) >5 cm/s or resistive index <0.75 = venous leak.

📊 Cavernosography (dynamic CT)

Gold standard for venous leak diagnosis. CT after intracavernosal injection maps the draining veins (dorsal, crural, cavernous) and guides embolization planning.

💊 Medical treatment first

PDE5 inhibitors (sildenafil, tadalafil) at maximum dose for ≥3 months before considering invasive investigation. Hormonal profile: testosterone, prolactin, LH, FSH.

🤝 Multidisciplinary approach

IR + urology/andrology coordination. Psychological assessment if mixed organic/psychogenic aetiology. IIEF-5 score before and after treatment.

→ Venous leak embolization → Varicocele embolization

🇫🇷 French version: dysfonction-erectile-causes.html

Why this page is trustworthy

Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: August 2026.

🏥 Le service 📰 Actualités 🔬 Recherche & essais cliniques

Erectile Dysfunction — Vascular Causes & Diagnosis