Functional and anatomic evaluation of penile arterial blood¯ow is essential in the work up of erectile dysfunction. Duplex ultrasonography is an ideal screening modality with cavernosal mean peak systolic blood¯ow velocity being the most sensitive predictor of arterial disease. Arterial variability of the penis may affect sonographic evaluation leading to frequent misinterpretation and therefore pudendal arteriography remains the current gold standard for penile arterial evaluation. Appreciation of the type and frequency of anatomic variants and potential collateral routes is important in interpreting penile arteriograms and in evaluating the hemodynamic signi®cance of suspected arterial disease.

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