Case: Male patient, 42 years old. Six months ago, he was found to have a mass in the lesser curvature of the stomach during a routine physical examination at his workplace, which was later confirmed to be gastric cancer. Twenty days ago, the patient found that the erectile hardness of his penis was not as hard as before, and recently the situation became worse, and he could not penetrate into the vagina and sex was suspended, so he came to the hospital. The patient had normal erectile function and no history of hypertension, hyperglycemia or cardiovascular disease. After detailed medical history and auxiliary examination, it was found that the thrombosis of the right internal iliac artery had led to significant narrowing of the arterial internal diameter, and the patient was admitted to the hospital. After admission, the patient received interventional treatment, and the “thrombus” was successfully removed. The pathological examination indicated that the histological type was gastric cancer, and the diagnosis was that the thrombus was formed by transvascular metastasis of gastric cancer. The patient’s erectile function was restored to normal after removal of the thrombus by interventional treatment. Case analysis: This is a special case of arterial erectile dysfunction. The patient had suffered from malignant gastric cancer, and the tumor cells were planted in the internal iliac artery and grew rapidly in the official lumen of the artery during transvascular metastasis, resulting in narrowing of the arterial lumen and insufficient blood supply to the corresponding area, including the cavernous body of the penis. Arterial erectile dysfunction is one of the common organic erectile dysfunctions. The most basic pathological changes are vascular lesions and narrowing of the arterial lumen for various reasons, which leads to insufficient blood supply to the penile corpus cavernosum, which in turn leads to insufficient blood supply to the penis, and the penis cannot get an erection, or can get an erection but the erection is not hard enough to penetrate the female vagina, so that sexual intercourse cannot be completed. Etiology: The etiology of arterial erectile dysfunction is diverse. Many diseases can involve the vascular system, disrupting vascular function and, in turn, leading to inadequate arterial blood supply and causing erectile dysfunction. Atherosclerosis is a common disease in middle-aged and elderly people, and its causative factors are complex and numerous, mainly including smoking, hypertension, hyperglycemia, hyperlipidemia and other common chronic diseases. The formation of atheromatous plaques in the inner walls of patients’ arteries leads to reduced vascular elasticity, luminal narrowing or even occlusion, and insufficient arterial blood supply. If such vascular lesions involve arteries associated with cavernous blood supply, they can lead to arterial erectile dysfunction in patients, the main clinical manifestation of which is progressive aggravation of erectile dysfunction (ED). The Massachusetts Male Aging Study (MMAS) showed that patients with heart disease, hypertension, hyperlipidemia, diabetes and other diseases have a significantly higher incidence of ED than the normal population of the same age. In addition, smoking is one of the important causative factors of ED, which can not only damage the function of vascular endothelial cells, but also an independent causative factor of atherosclerosis. It is also common to see cases of erectile dysfunction caused by arterial lumen narrowing due to improper medical treatment. The main clinical manifestation is the rapid onset of erectile dysfunction after the patient has previously had normal erectile function and undergone the associated surgery or treatment. For example, kidney transplant patients often have a new kidney ectopically transplanted onto the internal iliac artery, which not only diverts some of the blood flow from the internal iliac artery, but may also lead to scarring of the internal iliac artery vessel wall, resulting in narrowing of the vessel lumen, inadequate blood supply to downstream organs, and erectile dysfunction. In addition, aorto-iliac artery surgery and excessive doses of radiation therapy may lead to vascular injury and cause inadequate blood supply. Traumatic injuries, especially pelvic fractures, closed perineal injuries and straddling injuries, not only damage the blood vessels that supply blood to the penis, but also cause damage to the nerves that innervate the penile corpus cavernosum, and patients can develop severe erectile dysfunction. These patients often have no obvious abnormalities in sexual function before the injury, and immediately after the injury, symptoms such as erectile dysfunction,, penile numbness, and urinary incontinence occur. These patients are generally better treated for those who still have intact nerve function. Treatment: Surgery for arterial erectile dysfunction has been available for more than 40 years, and to date, there are more than 100 surgical procedures alone. However, the long-term outcome is still not well known as there is no long-term follow-up information. The most commonly used surgical approach is the submental artery-dorsal deep penile artery vascular anastomosis. This approach is mainly used in younger patients with arterial erectile dysfunction who have had the disease for a short period of time. Most of these patients are caused by trauma to the pelvis or perineum and are generally in good general condition without serious vascular disease, endocrine dysfunction, penile fibrosis, etc. In contrast, for patients with irreparable severe nerve injury or whose penile corpus cavernosum has become fibrotic, this arterial anastomosis is not effective, and if the patient’s physical condition allows, penile prosthesis implantation may be an option. The efficacy of arterial anastomosis for arterial erectile dysfunction varies depending on the procedure and the patient’s own condition. The immediate results are generally considered to be significant, with an efficiency rate of 50%-70%, while the long-term results are not as satisfactory.