Introduction: Endovascular hemorrhoidal artery embolization has emerged as an analogous therapy to Doppler-guided ligation. The purpose of this study was to evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids.
Methods: One hundred and twenty-six patients with symptomatic bleeding internal hemorrhoids refractory to prior treatment (e.g., banding, dietary/lifestyle modifications) were treated between August 2021 and May 2022 (62 men and 64 women). The average age was 58.3 +/- 15.8 years with an average Goligher's hemorrhoid grade of 2.2. Patients underwent superior and/or middle rectal artery embolization to the target arteries demonstrating abnormal vascular blush of the hemorrhoidal cushion with spherical embolic particles (500 or 600 micron) and/or microcoils (2-6 mm). Patients were discharged two hours post-procedure and were evaluated at baseline and 1-month for the following standardized outcomes: hemorrhoid related pain (HRP, 0-10), hemorrhoid symptoms score (HSS, 5-20), quality of life (QoL, 0-4), French bleeding score (FBS, 0-9), and hemorrhoid grade (0-4).
Results: Femoral (121/126) or radial access (5/126) was performed and successful embolization of the superior and/or middle rectal artery was achieved in 126/126 (100%) patients. Statistically significant improvements in all outcomes were reported at follow-up (baseline vs 1 month): HRP (4.6 vs 1.7, p < 0.001), HSS (10.2 vs 7.1, p < 0.001), QoL (2.4 vs 0.7, p < 0.001), FBS (3.9 vs 1.5, p < 0.001), and hemorrhoid grade (2.0 vs 1.6, p = 0.03). One minor adverse event was reported: post-procedural peri-anal pain that required topical cream, which resolved soon after treatment. No major adverse events were reported.
Discussion: Hemorrhoidal artery embolization is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids.
.jpg "Atul Marathe, MD photo")