Hemorrhoid Artery Embolization

Overview

Hemorrhoids are a common anorectal disease, defined as the enlargement and symptomatic prolapse of the hemorrhoidal cushions. It affects millions of people around the world and is a major medical and socioeconomic problem.

Hemorrhoidal disease is a common problem. There are a variety of options, surgical and nonsurgical, for the treatment of hemorrhoids. Most hemorrhoidal problems can be managed without surgery.

As a first step, hygienic and dietary measures are recommended to reverse the pathophysiological mechanism of hemorrhoidal disease and to reduce symptoms. Patients should also be counseled on changing their lifestyle.

Causes

Hemorrhoids are caused by vascular congestion and the swelling of veins in the lower rectum and anus, often triggered by chronic straining, constipation, and pregnancy.

• Chronic, Untreated Bleeding.

• Failed Conservative Management.

• Internal and External Hemorrhoids.

• Refusal or Inability to Undergo Surgery.

• Rectal Arteriovenous Malformations (AVMs).

Symptoms

• Mild to Moderate Pain/Tenderness.

• Rectal Bleeding/Discharge.

• “Post-Embolisation Syndrome”.

• Sensation of Pressure.

•Persistent.

Risk Factor

• Contrast Dye Sensitivity.

• Renal Impairment.

• Previous Pelvic Radiation.

• Non-Target Embolization.

• Infection.

Diagnosis

Physical Examination: Includes a digital rectal exam (DRE) and inspection during straining to assess the grade of prolapse.
Symptom Scoring: Physicians use the French Bleeding Score (FBS) to quantify bleeding severity (on a scale of 0 to 9) and the Visual Analog Scale (VAS) to measure pain levels.
Goligher Classification: This is the standard for grading internal hemorrhoids from I (no prolapse) to IV (irreducible prolapse). HAE is most effective for Grades I to III.
Colonoscopy or Anoscopy: An up-to-date colonoscopy is essential to rule out other pathologies like anorectal cancer, polyps, or inflammatory bowel disease (IBD).
CT Angiography (CTA): While not always systematic, CTA of the abdomen and pelvis is often performed to map the vascular anatomy, identify potential atherosclerosis, and detect anatomical variations like a hypertrophic middle rectal artery (MRA).
Laboratory Work: Blood tests are used to check for anemia and ensure adequate kidney function for the contrast dye used during the procedure.

Benefits vs. Traditional Surgery (e.g., Hemorrhoidectomy):

Reduced Pain: Because it avoids rectal trauma, it is considered much less painful.
Fast Recovery: Minimal downtime compared to the weeks needed for surgical recovery.
Lower Risk: Reduced risk of bleeding and complications.

Benefits of Hemorrhoid Artery Embolization

Performed by an interventional radiologist via a small catheter, usually through the radial artery (wrist) or femoral artery (groin). It typically lasts 45 minutes to 2 hours.

High success rates in reducing or eliminating bleeding, often within 2–4 weeks.

No surgery, no incisions, no General Anesthesia, and minimal post-procedure pain.

Patients usually return home the same day and can return to normal activities very quickly.

Primarily designed for symptomatic internal hemorrhoids (often grades II-IV), particularly for patients who failed banding or want to avoid traditional surgery.

It does not treat external hemorrhoids and may not be effective for all, with a potential need for a second procedure for some patients.

Above article is for information purpose only

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