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Semin intervent Radiol 2025; 42(01): 093-100
DOI: 10.1055/s-0044-1801360
Review Article

Rectal Artery Embolization for the Treatment of Hemorrhoidal Disease

Seyed S. Zakavi
1   Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
,
Mohammad Mirza-Aghazadeh-Attari
2   Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
,
Arian Mansur
3   Harvard Medical School, Boston, Massachusetts
,
Peiman Habibollahi
4   Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
,
Nariman Nezami
5   Division of Vascular and Interventional Radiology, Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
6   Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia
7   Lombardi Comprehensive Cancer Center, Washington, District of Columbia
8   The Fischell Department of Bioengineering, University of Maryland College Park, College Park, Maryland
,
Juan C. Camacho
9   Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, Florida
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Abstract

The term “hemorrhoid” is commonly invoked to characterize the pathologic process of symptomatic hemorrhoidal disease instead of the normal anatomic structure. While often treated with conservative measures, rectal artery embolization offers a minimally invasive alternative for patients with persistent or severe symptoms. This technique involves blocking the blood supply to the hemorrhoids using embolic agents, reducing blood flow, and alleviating symptoms. This review explores the clinical evaluation, techniques, and outcomes associated with rectal artery embolization for the treatment of hemorrhoidal disease. A discussion of the pathophysiology of hemorrhoids, the anatomy of rectal arteries, and the embolization procedure is provided in detail. Additionally, the safety and efficacy of the technique, including potential complications and outcomes, are reviewed.

Keywords

hemorrhoid - emborrhoid - rectal artery - endovascular therapy - interventional radiology


Publication History

Article published online:
24 January 2025

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  • References

  • 1 Giurazza F, Corvino F, Cavaglià E. et al. Emborrhoid in patients with portal hypertension and chronic hemorrhoidal bleeding: preliminary results in five cases with a new coiling release fashion “Spaghetti technique”. Radiol Med 2020; 125 (10) 1008-1011
    Search in Google Scholar
  • 2 Peery AF, Sandler RS, Galanko JA. et al. Risk factors for hemorrhoids on screening colonoscopy. PLoS One 2015; 10 (09) e0139100
    Search in Google Scholar
  • 3 Riss S, Weiser FA, Schwameis K. et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis 2012; 27 (02) 215-220
    Search in Google Scholar
  • 4 Kibret AA, Oumer M, Moges AM. Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One 2021; 16 (04) e0249736
    Search in Google Scholar
  • 5 Fontem RF, Eyvazzadeh D. Internal Hemorrhoid. . [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. . Available at: https://www.ncbi.nlm.nih.gov/books/NBK537182/ . Accessed January 6, 2024
    Search in Google Scholar
  • 6 Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 2012; 18 (17) 2009-2017
    Search in Google Scholar
  • 7 Wang L, Ni J, Hou C. et al. Time to change? Present and prospects of hemorrhoidal classification. Front Med (Lausanne) 2023; 10: 1252468
    Search in Google Scholar
  • 8 Liang Y, Ren T, Li R. et al. Natural products with potential effects on hemorrhoids: a review. Molecules 2024; 29 (11) 2673
    Search in Google Scholar
  • 9 Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist's view. World J Gastroenterol 2015; 21 (31) 9245-9252
    Search in Google Scholar
  • 10 Rebonato A, Maiettini D, Patriti A. et al. Hemorrhoids embolization: state of the art and future directions. J Clin Med 2021; 10 (16) 3537
    Search in Google Scholar
  • 11 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
    Search in Google Scholar
  • 12 Aimaiti A, A Ba Bai Ke Re MMTJ, Ibrahim I, Chen H, Tuerdi M. Mayinuer Sonographic appearance of anal cushions of hemorrhoids. World J Gastroenterol 2017; 23 (20) 3664-3674
    Search in Google Scholar
  • 13 Ng KS, Holzgang M, Young C. Still a case of “no pain, no gain”? An updated and critical review of the pathogenesis, diagnosis, and management options for hemorrhoids in 2020. Ann Coloproctol 2020; 36 (03) 133-147
    Search in Google Scholar
  • 14 Yalcinkaya A, Yalcinkaya A, Atici SD, Sahin C, Leventoglu S. T E H Study Collaboration. Local excision versus thrombectomy in thrombosed external hemorrhoids: a multicenter, prospective, observational study. BMC Surg 2023; 23 (01) 228
    Search in Google Scholar
  • 15 Ray-Offor E, Amadi S. Hemorrhoidal disease: predilection sites, pattern of presentation, and treatment. Ann Afr Med 2019; 18 (01) 12-16
    Search in Google Scholar
  • 16 Margetis N. Pathophysiology of internal hemorrhoids. Ann Gastroenterol 2019; 32 (03) 264-272
    Search in Google Scholar
  • 17 Νikolouzakis ΤΚ, Mariolis-Sapsakos T, Triantopoulou C. et al. Detailed and applied anatomy for improved rectal cancer treatment. Ann Gastroenterol 2019; 32 (05) 431-440
    Search in Google Scholar
  • 18 Toiyama Y, Kusunoki M. Changes in surgical therapies for rectal cancer over the past 100 years: a review. Ann Gastroenterol Surg 2020; 4 (04) 331-342
    Search in Google Scholar
  • 19 Sanchez C, Chinn BT. Hemorrhoids. Clin Colon Rectal Surg 2011; 24 (01) 5-13
    Search in Google Scholar
  • 20 Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol 2019; 17 (01) 8-15
    Search in Google Scholar
  • 21 Patrício J, Bernades A, Nuno D, Falcão F, Silveira L. Surgical anatomy of the arterial blood-supply of the human rectum. Surg Radiol Anat 1988; 10 (01) 71-75
    Search in Google Scholar
  • 22 Lawrence A, McLaren ER. External Hemorrhoid. . [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. . Available at: https://www.ncbi.nlm.nih.gov/books/NBK500009/ . Accessed January 6, 2025
    Search in Google Scholar
  • 23 Brillantino A, Skokowski J, Ciarleglio FA. et al. Inferior mesenteric artery ligation level in rectal cancer surgery beyond conventions: a review. Cancers (Basel) 2023; 16 (01) 72
    Search in Google Scholar
  • 24 Boutros M, Gordon PH. Anatomy and physiology of the colon, rectum, and anal canal. Current Therapy in Colon and Rectal Surgery, 3rd ed. Elsevier; , Philadelphia; 2017: 3-11
    Search in Google Scholar
  • 25 Hassan A, Al Mamun A. Surgical anatomy of anal canal and rectum. Benign Anorectal Disorders: A Guide to Diagnosis and Management:. Springer;; 2016: 1-6
    Search in Google Scholar
  • 26 Panneau J, Mege D, Biseglie MD. et al. Emborrhoid: rectal artery embolization for hemorrhoid disease. Semin Intervent Radiol 2022; 39 (02) 194-202
    Search in Google Scholar
  • 27 Mott T, Latimer K, Edwards C. Hemorrhoids: diagnosis and treatment options. Am Fam Physician 2018; 97 (03) 172-179
    Search in Google Scholar
  • 28 Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg 2016; 29 (01) 22-29
    Search in Google Scholar
  • 29 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
    Search in Google Scholar
  • 30 McKeown DG, Goldstein S. Hemorrhoid Banding. National Library of Medicine; 2020
    Search in Google Scholar
  • 31 Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet 1989; 1 (8634) 349-352
    Search in Google Scholar
  • 32 Raman SP, Horton KM, Fishman EK. MDCT and CT angiography evaluation of rectal bleeding: the role of volume visualization. AJR Am J Roentgenol 2013; 201 (03) 589-597
    Search in Google Scholar
  • 33 Sandoval Y, Bell MR, Gulati R. Transradial artery access complications. Circ Cardiovasc Interv 2019; 12 (11) e007386
    Search in Google Scholar
  • 34 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
    Search in Google Scholar
  • 35 Buso Gil S, Ferrer Puchol MD, Solaz Solaz J, Esteban Hernández E. Prevalent technique and results of hemorrhoidal embolization. J Clin Med 2022; 11 (22) 6631
    Search in Google Scholar
  • 36 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
    Search in Google Scholar
  • 37 Wang X, Sheng Y, Wang Z. et al. Comparison of different embolic particles for superior rectal arterial embolization of chronic hemorrhoidal bleeding: gelfoam versus microparticle. BMC Gastroenterol 2021; 21 (01) 465
    Search in Google Scholar
  • 38 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
    Search in Google Scholar
  • 39 Talaie R, Torkian P, Moghadam AD. et al. Hemorrhoid embolization: a review of current evidences. Diagn Interv Imaging 2022; 103 (01) 3-11
    Search in Google Scholar
  • 40 Han X, Xia F, Chen G. et al. Superior rectal artery embolization for bleeding internal hemorrhoids. Tech Coloproctol 2021; 25 (01) 75-80
    Search in Google Scholar
  • 41 Morsi S, Linares Bolsegui M, Kobeissi H. et al. Common design and data elements on rectal artery embolization for treatment of symptomatic internal hemorrhoidal disease: an interactive systematic review of clinical trials. CVIR Endovasc 2024; 7 (01) 45
    Search in Google Scholar
  • 42 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
    Search in Google Scholar
  • 43 Tradi F, Louis G, Giorgi R. et al. Embolization of the superior rectal arteries for hemorrhoidal disease: prospective results in 25 patients. J Vasc Interv Radiol 2018; 29 (06) 884-892.e1
    Search in Google Scholar
  • 44 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
    Search in Google Scholar
  • 45 Zhou H, Li L, Wang WJ, Li YL. [Clinical analysis of percutaneous superselective superior rectal artery embolization for grades II-III internal hemorrhoids]. Zhonghua Nei Ke Za Zhi 2024; 63 (09) 861-865
    Search in Google Scholar
  • 46 Nguyenhuy M, Xu Y, Kok HK. et al. Clinical outcomes following rectal artery embolisation for the treatment of internal haemorrhoids: a systematic review and meta-analysis. Cardiovasc Intervent Radiol 2022; 45 (09) 1351-1361
    Search in Google Scholar
  • 47 Makris GC, Thulasidasan N, Malietzis G. et al. Catheter-directed hemorrhoidal dearterialization technique for the management of hemorrhoids: a meta-analysis of the clinical evidence. J Vasc Interv Radiol 2021; 32 (08) 1119-1127
    Search in Google Scholar
  • 48 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
    Search in Google Scholar
  • 49 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
    Search in Google Scholar
  • 50 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
    Search in Google Scholar
  • 51 Jinghua L, Qixue L, Chunyan W, Yuguang S. Clinical safety and effectiveness of upper rectal artery embolization in patients with internal hemorrhoids. J Clin Med Pract 2023; 27 (09) 119-122
    Search in Google Scholar
  • 52 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
    Search in Google Scholar
  • 53 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
    Search in Google Scholar