Arteriography of the penile arteries in patients with pharmacologic erection has been performed by our group since 1983. Pathological Doppler findings and weak response to locally administered papaverine or alpha-blocking agents in these impotent men led to pharmacoangiography in 17 of 372 patients with erectile dysfunction; of these 372 patients 130 (35%) had subnormal penile blood flow according to Doppler ultrasonography. Only one had a proximal lesion (occlusion of the right common iliac artery) while the rest had distal lesions. Three patients were nonsmokers and the remaining 14 patients (82%) were smokers or had smoked previously. Only 2 of the 14 had other predisposing diseases.