Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000068.xml
Download PDF
Semin intervent Radiol 2024; 41(03): 263-269
DOI: 10.1055/s-0044-1788056
DOI: 10.1055/s-0044-1788056
Review Article
Imaging for Hemorrhoidal Disease: Navigating Rectal Artery Embolization from Planning to Follow-up
Funding No funding was provided for this manuscript.
Abstract
Hemorrhoid disease is very common, affecting greater than one-third of adults. Conservative management and several office-based procedures are useful in the treatment of internal hemorrhoids. Patients with refractory hemorrhoid disease have traditionally been treated with surgical hemorrhoidectomy. Rectal artery embolization has emerged as an alternative to surgical hemorrhoidectomy and has been shown to be safe and effective in case series and clinical trials completed over the past decade. Embolization has significantly less postprocedure pain when compared with surgical hemorrhoidectomy with similar outcomes. Pre- and postprocedure imaging are not routinely performed. Intraprocedural imaging consists of selective catheterization of the superior rectal arteries from the inferior mesenteric artery, and the middle rectal arteries from the internal iliac artery. The inferior rectal artery is seldom embolized due to the supply of the levator ani muscle and skin. To date, intermediate and large particles and fibered and nonfibered coils have been used successfully.
Keywords
internal hemorrhoids - rectal artery embolization - hemorrhage - rectal bleeding - interventional radiologyPublication History
Article published online:
19 August 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Everhart JE, Ruhl CE. Burden of digestive diseases in the United States part II: lower gastrointestinal diseases. Gastroenterology 2009; 136 (03) 741-754
- 2 Peery AF, Sandler RS, Galanko JA. et al. Risk factors for hemorrhoids on screening colonoscopy. PLoS One 2015; 10 (09) e0139100
- 3 Etzioni DA, Beart Jr RW, Madoff RD, Ault GT. Impact of the aging population on the demand for colorectal procedures. Dis Colon Rectum 2009; 52 (04) 583-590 , discussion 590–591
- 4 Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol 2019; 17 (01) 8-15
- 5 Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg 2016; 29 (01) 22-29
- 6 Burkitt D. . Varicose Veins, Deep Vein Thrombosis and Haemorrhoids. Refined Carbohydrate Foods Disease. Elsevier; 1975: 143-160
- 7 Burkitt DP, Graham-Stewart CW. Haemorrhoids – postulated pathogenesis and proposed prevention. Postgrad Med J 1975; 51 (599) 631-636
- 8 Burkitt DP. Varicose veins, deep vein thrombosis, and haemorrhoids: epidemiology and suggested aetiology. BMJ 1972; 2 (5813) 556-561
- 9 Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 1990; 98 (02) 380-386
- 10 Delcò F, Sonnenberg A. Associations between hemorrhoids and other diagnoses. Dis Colon Rectum 1998; 41 (12) 1534-1541 , discussion 1541–1542
- 11 Dehn TC, Kettlewell MG. Haemorrhoids and defaecatory habits. Lancet 1989; 1 (8628) 54-55
- 12 Jacobs DO. Hemorrhoids: what are the options in 2018?. Curr Opin Gastroenterol 2018; 34 (01) 46-49
- 13 Alonso-Coello P, Mills E, Heels-Ansdell D. et al. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Off J Am Coll Gastroenterol 2006; 101 (01) 181-188
- 14 Perera N, Liolitsa D, Iype S. et al. Phlebotonics for haemorrhoids. Cochrane Database Syst Rev 2012; (08) CD004322
- 15 Iyer VS, Shrier I, Gordon PH. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 2004; 47 (08) 1364-1370
- 16 Brown SR, Tiernan JP, Watson AJM. et al; HubBLe Study Team. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 2016; 388 (10042): 356-364
- 17 Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon Rectum 1959; 2 (02) 176-179
- 18 Milligan E, Morgan CN, Jones L, Officer R. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet 1937; 230 (5959) 1119-1124
- 19 Shaikh AR, Dalwani AG, Soomro N. An evaluation of milligan-morgan and Ferguson procedures for haemorrhoidectomy at Liaquat University Hospital Jamshoro, Hyderabad, Pakistan. Pak J Med Sci 2013; 29 (01) 122-127
- 20 Vidal V, Louis G, Bartoli JM, Sielezneff I. Embolization of the hemorrhoidal arteries (the emborrhoid technique): a new concept and challenge for interventional radiology. Diagn Interv Imaging 2014; 95 (03) 307-315
- 21 Abd El Tawab K, Salem AA, Khafagy R. New technique of embolization of the hemorrhoidal arteries using embolization particles alone: retrospective results in 33 patients. Arab J Intervent Radiol 2020; 4 (01) 27-31
- 22 Campennì P, Iezzi R, Marra AA. et al. The emborrhoid technique for treatment of bleeding hemorrhoids in patients with high surgical risk. J Clin Med 2022; 11 (19) 5533
- 23 Han X, Xia F, Chen G. et al. Superior rectal artery embolization for bleeding internal hemorrhoids. Tech Coloproctol 2021; 25 (01) 75-80
- 24 Moussa N, Bonnet B, Pereira H. et al. Mid-term results of superior rectal artery and coils for hemorrhoidal embolization with particles bleeding. Cardiovasc Intervent Radiol 2020; 43 (07) 1062-1069
- 25 Moussa N, Sielezneff I, Sapoval M. et al. Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease. Colorectal Dis 2017; 19 (02) 194-199
- 26 Park S, Kim Y, Shin JH. et al. Outcome of rectal arterial embolization for rectal bleeding in 34 patients: a single-center retrospective study over 20 years. J Vasc Interv Radiol 2020; 31 (04) 576-583
- 27 Stecca T, Farneti F, Balestriero G. et al. Superior rectal artery embolization for symptomatic grades 2 and 3 hemorrhoidal disease: 6-month follow-up among 43 patients. J Vasc Interv Radiol 2021; 32 (09) 1348-1357
- 28 Sun X, Xu J, Zhang J, Jin Y, Chen Q. Management of rectal bleeding due to internal haemorrhoids with arterial embolisation: a single-centre experience and protocol. Clin Radiol 2018; 73 (11) 985.e1-985.e6
- 29 Venturini M, De Nardi P, Marra P. et al. Embolization of superior rectal arteries for transfusion dependent haemorrhoidal bleeding in severely cardiopathic patients: a new field of application of the “emborrhoid” technique. Tech Coloproctol 2018; 22 (06) 453-455
- 30 Vidal V, Sapoval M, Sielezneff Y. et al. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases. Cardiovasc Intervent Radiol 2015; 38 (01) 72-78
- 31 Bagla S, Pavidapha A, Lerner J. et al. Outcomes of hemorrhoidal artery embolization from a multidisciplinary outpatient interventional center. J Vasc Interv Radiol 2023; 34 (05) 745-749
- 32 De Gregorio MA, Bernal R, Ciampi-Dopazo JJ, Urbano J, Millera A, Guirola JA. Safety and effectiveness of a new electrical detachable microcoil for embolization of hemorrhoidal disease, November 2020-December 2021: results of a prospective study. J Clin Med 2022; 11 (11) 3049
- 33 De Gregorio MA, Guirola JA, Serrano-Casorran C. et al. Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I-III): prospective outcomes from a Spanish emborrhoid registry. Eur Radiol 2023; 33 (12) 8754-8763
- 34 Küçükay MB, Küçükay F. Superior rectal artery embolization with tris-acryl gelatin microspheres: a randomized comparison of particle size. J Vasc Interv Radiol 2021; 32 (06) 819-825
- 35 Moreira AM, de Assis AM, Carnevale FC, Antunes AA, Srougi M, Cerri GG. A review of adverse events related to prostatic artery embolization for treatment of bladder outlet obstruction due to BPH. Cardiovasc Intervent Radiol 2017; 40 (10) 1490-1500
- 36 Moreira AM, Marques CFS, Antunes AA. et al. Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature. Cardiovasc Intervent Radiol 2013; 36 (06) 1690-1694
- 37 Falsarella PM, Nasser F, Affonso BB. et al. Embolization of the superior rectal arteries versus closed hemorrhoidectomy (Ferguson technique) in the treatment of hemorrhoidal disease: a randomized clinical trial. J Vasc Interv Radiol 2023; 34 (05) 736-744.e1
- 38 Ayoub SF. Arterial supply to the human rectum. Acta Anat (Basel) 1978; 100 (03) 317-327
- 39 Kiyomatsu T, Ishihara S, Murono K. et al. Anatomy of the middle rectal artery: a review of the historical literature. Surg Today 2017; 47 (01) 14-19
- 40 Bilhim T, Pisco JM, Rio Tinto H. et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 2012; 23 (11) 1403-1415
- 41 Heinze T, Fletcher J, Miskovic D, Stelzner S, Bayer A, Wedel T. The middle rectal artery: Revisited anatomy and surgical implications of a neglected blood vessel. Dis Colon Rectum 2023; 66 (03) 477-485
- 42 Boxall TA, Smart PJ, Griffiths JD. The blood-supply of the distal segment of the rectum in anterior resection. Br J Surg 1963; 50 (222) 399-404
- 43 Bilhim T, Pereira JA, Tinto HR. et al. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat 2013; 35 (06) 517-522
- 44 Jones OM, Smeulders N, Wiseman O, Miller R. Lateral ligaments of the rectum: an anatomical study. Br J Surg 1999; 86 (04) 487-489
- 45 Sato K, Sato T. The vascular and neuronal composition of the lateral ligament of the rectum and the rectosacral fascia. Surg Radiol Anat 1991; 13 (01) 17-22
- 46 DiDio LJ, Diaz-Franco C, Schemainda R, Bezerra AJ. Morphology of the middle rectal arteries. A study of 30 cadaveric dissections. Surg Radiol Anat 1986; 8 (04) 229-236
- 47 Drummond H. The arterial supply of the rectum and pelvic colon. J Br Surg 1913; 1 (04) 677-685
- 48 Nano M, Dal Corso HM, Lanfranco G, Ferronato M, Hornung JP. Contribution to the surgical anatomy of the ligaments of the rectum. Dis Colon Rectum 2000; 43 (11) 1592-1597 , discussion 1597–1598
- 49 Parsons FG, Keith A. Sixth annual report of the committee of collective investigation of the Anatomical Society of Great Britain and Ireland, 1895–96. J Anat Physiol 1896; 31 (Pt 1): 31-44
- 50 Widmer O. Die Rectalarterien des Menschen; Eintritt, Kaliber, Verteilungsart, Anastomosen und Versorgungsgebiete. Z Anat Entwicklungsgesch 1955; 118 (05) 398-416
- 51 Shafik A, Mostafa H. Study of the arterial pattern of the rectum and its clinical application. Acta Anat (Basel) 1996; 157 (01) 80-86
- 52 Goligher J. ed. Haemorrhoids or piles. In: Surgery of the Anus, Rectum and Colon. London:: Bailliere Tindall; 1980
- 53 Goligher JC. Surgery of the Anus, Rectum and Colon. London: Bailliere Tindall;; 1980: 924-925
- 54 Fathallah N, Beaussier H, Chatellier G. et al. Proposal for a new score: hemorrhoidal bleeding score. Ann Coloproctol 2021; 37 (05) 311-317
- 55 Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8 (12) 1153-1157
- 56 Rørvik HD, Davidsen M, Gierløff MC, Brandstrup B, Olaison G. Quality of life in patients with hemorrhoidal disease. Surg Open Sci 2023; 12: 22-28
- 57 Rørvik HD, Styr K, Ilum L. et al. Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: new tools to evaluate symptoms and health-related quality of life in hemorrhoidal disease. Dis Colon Rectum 2019; 62 (03) 333-342
- 58 O'leary MP. Validity of the “bother score” in the evaluation and treatment of symptomatic benign prostatic hyperplasia. Rev Urol 2005; 7 (01) 1-10
- 59 Maclean D, Maher B, Harris M. et al. Planning prostate artery embolisation: is it essential to perform a pre-procedural CTA?. Cardiovasc Intervent Radiol 2018; 41 (04) 628-632
- 60 Little MW, Macdonald AC, Boardman P. et al. Effects of sublingual glyceryl trinitrate administration on the quality of preprocedure CT angiography performed to plan prostate artery embolization. J Vasc Interv Radiol 2018; 29 (02) 225-228
- 61 Isaacson AJ, Burke LM. Utility of Pelvic Computed Tomography Angiography Prior to Prostatic Artery Embolization. Thieme Medical Publishers;; 2016: 224-230
- 62 Bagla S, Rholl KS, Sterling KM. et al. Utility of cone-beam CT imaging in prostatic artery embolization. J Vasc Interv Radiol 2013; 24 (11) 1603-1607
- 63 Hermie L, Dhondt E, Vanlangenhove P, De Waele J, Degroote H, Defreyne L. Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding. Eur Radiol 2021; 31 (04) 2161-2172
- 64 Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovasc Intervent Radiol 2013; 36 (06) 1452-1463
- 65 Eberspacher C, Ficuccilli F, Tessieri L. et al. Annoyed with haemorrhoids? Risks of the emborrhoid technique. Dig Dis Sci 2021; 66 (11) 3725-3729
- 66 Oliveira D, Assis A, Hora JB. et al. Abstract No. 40 Embolization of the superior and middle rectal arteries for the treatment of symptomatic hemorrhoidal disease using the combination of metallic coils and microspheres. J Vasc Interv Radiol 2023; 34 (03) 20