Hospital das Clínicas - HCFMUSP University of Sao Paulo Medical School São Paulo, Sao Paulo, Brazil
Background: The emborrhoid technique consists of the embolization of the hemorrhoidal arteries for the treatment of hemorrhoidal bleeding disease. The original technique comprises the endovascular arterial occlusion performed using coils placed in the terminal branches of the superior rectal arteries
Purpose/Objective: To investigate the feasibility and initial results of superior and middle rectal artery embolization for patients with symptomatic hemorrhoidal disease.
Materials & Methods: Prospective, single-center, included 10 patients undergoing superior (SRA) and middle rectal arteries (MRA) embolization with microspheres and coils, follow-up of 6 months. Embolization planning with Embo ASSIST (GE HealthCare). Inclusion: Symptomatic hemorrhoidal disease, refractory to clinical treatment, Goligher classification II or III. Exclusion: Previous hemorrhoidal surgery and Goligher classification IV. Technical success defined as successful catheterization and embolization of hemorrhoidal arteries. Hemorrhoid severity (HSS) and Quality of Life (QoL) scores used to evaluate clinical outcomes. Adverse event defined according to the Society of interventional Radiology in minor or major complications.
Results: Ten patients (4 men, 6 women), with mean age of 59 +/- 13. Goligher classification level II in 70% and III in 30% of patients. Technical success achieved in all patients. SRA 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 duration time of procedures was 102,5 +/- 38 min. HSS and QoL scores improved 91% and 85% respectively, without clinical recurrence at 6 months follow-up. One patient (10%) had rectal ischemia requiring surgical treatment.
Conclusion: Embolization of SRA and MRA was feasible and improved symptoms and QoL in patients with grade II-III hemorrhoidal disease. No recurrence observed during first 6-month follow-up. One major complication was observed, raising the need to further investigate the safety and limitations of this technique.
