Embolization of the Superior and Middle Rectal Arteries for the Treatment of Symptomatic Hemorrhoidal Disease using the Combination of Metallic coils and Microspheres

Prospective, single-center cohort that included 10 consecutive patients who underwent superior (SRA) and middle rectal arteries (MRA) embolization with microspheres (1100 μm) and metallic coils, with a follow-up period of 6 months. Embolizations planning and guidance was performed using Embo_ASSIST software with virtual injection (GE Healthcare, IL).

Inclusion criteria comprised: Symptomatic hemorrhoidal disease refractory to clinical treatment, and with Goligher classification II or III. Exclusion criteria were: Previous surgery for hemorrhoidal disease and Goligher classification IV. Technical success was defined as successful catheterization and embolization of the hemorrhoidal arteries using  the EmboASSIST software. haemorrhoid severity (HSS) and the Quality of Life (QoL) scores were used to evaluate the clinical outcomes. Procedure-related adverse event was defined according to the  Society of interventional Radiology in minor or major complications.

Results:

Ten patients (4 men, 6 women) underwent rectal arteries embolization for haemorrhoidal bleeding disease, with a mean age of 59 (+/- 13) years old. Goligher classification were level II in 70% and 3 in 30% of patients. Technical success was achieved in all patients. SRA were embolized in 100% and MRA in 80%  (90% unilateral and bilateral in 10%). Mean time off work after hospital discharge was 1.4 (+/- 0.7) days. Median procedures time was 102,5 (+/- 38) minutes. The HSS and QoL scores improved 91% and 85% respectively, without clinical recurrence at the 6 months follow-up (table 1). One patient (10%) had a rectal ischemia that required surgical treatment. 

Conclusion:

Embolization of both superior and middle rectal arteries was feasible and improved symptoms and quality of life in patients with grade II-III hemorrhoidal disease. No clinical recurrence was observed during the first 6-month follow-up.

One major complication was observed, addressing the need of further investigation of the safety and limits of this technique in future trials.