Embolization for the Treatment of Symptomatic Hemorrhoids: A Primer for the Interventional Radiologist

- Review the anatomy and characteristics of hemorrhoids

- Review the variable superior, middle and inferior rectal artery anatomy

- Review treatments of hemorrhoids including band ligation, excision, and embolization

- Review current guidelines for hemorrhoid artery embolization

- Review technique, advantages, and disadvantages of the “emborrhoid” technique

Background:

Hemorrhoids are a bothersome clinical condition commonly affecting patients age 45-65. They occur most commonly in men, and have associations with diet and bathroom habits. Hemorrhoids can result in pain, bleeding, and aesthetic concerns for patients. Hemorrhoids gain greater clinical significance when they become ulcerated or incarcerated putting patients at risk of infection. Internal hemorrhoids are further classified into four grades based on extent of prolapse, bleeding, and reducibility. The goal of this educational abstract is to review hemorrhoid characteristics, discuss treatment options, and highlight the relatively new procedure of a hemorrhoid artery embolization.

Clinical Findings/Procedure Details:

Twelve current clinical studies published on hemorrhoid embolization were analyzed and were found to come primarily from Europe, used coils and/or microspheres, had 1 to 12 months of follow-up, and had an average cohort of 25 patients treated. There are five described anatomical variations of the SRA, MRA, and IRA important to consider if planning an emborrhoid procedure. Complications and limitations of the emborrhoid technique will be discussed. Considerations regarding embolic used will also be addressed, in addition to possible future use of liquid embolics to ensure distal penetration.

Conclusion and/or Teaching Points:

Hemorrhoids are a common and morbid condition affecting much of the population. Hemorrhoids have become a clinical focus for interventional radiologists since the advent of the emborrhoid technique as an alternative to invasive surgical removal. Evidence for the efficacy of hemorrhoid artery embolization compared to other treatments is currently limited. Randomized controlled trials with longer patient follow-up are necessary to further establish this novel technique.