Embolization of Hemorrhoidal Arteries: A Novel Endovascular Therapy Option for the Treatment of Hemorrhoidal Disease

Abstract

Background Hemorrhoids are a widespread disease. Treatment options range from dietary measures to open surgery. A novel treatment approach is the embolization of the hemorrhoidal arteries.

Method A review was performed based on a selective literature search in PubMed representing the current state of research. The keywords “hemorrhoid” and “embolization” and “emborrhoid” were used. In addition, technical details of the hemorrhoidal embolization procedure are explained.

Results and Conclusion Embolization of hemorrhoidal arteries is a safe treatment, which allows efficient symptom control even in patients with contraindications for open surgery.

Key Points: 

• Embolization of hemorrhoidal arteries is a new approach to the treatment of hemorrhoids.

• Embolization of hemorrhoidal arteries is feasible in patients with contraindications for open surgery such as hypercoaguable states and contraindications for general anesthesia.

• The endovascular approach causes no rectal and anal trauma and associated complications can be avoided.

• The treatment of bleeding hemorrhoids seems to be particularly effective.

• No ischemic complications have been reported so far when coils as well as particles were used.

Citation Format

• Feyen L, Freyhardt P, Schott P et al. Hämorrhoidenembolisation: Eine neue minimalinvasive endovaskuläre Therapieoption bei Hämorrhoidalleiden. Fortschr Röntgenstr 2022; 194: 266 – 271

Key words

hemorrhoids - embolization - rectal artery

Publication History

Received: 05 January 2021

Accepted: 12 September 2021

Article published online:
18 November 2021

• References

• 1 Aigner F, Bodner G, Conrad F. et al. The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 2004; 187: 102-108 DOI: 10.1016/j.amjsurg.2002.11.003.
• 2 Lierse W. [Anatomy and pathophysiology of hemorrhoids]. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir 1989; 769-772
• 3 Aigner F, Conrad F, Haunold I. et al. [Consensus statement haemorrhoidal disease]. Wien Klin Wochenschr 2012; 124: 207-219 DOI: 10.1007/s00508-011-0107-8.
• 4 Cataldo P, Ellis CN, Gregorcyk S. et al. Practice parameters for the management of hemorrhoids (revised). Dis Colon Rectum 2005; 48: 189-194 DOI: 10.1007/s10350-004-0921-4.
• 5 Morgado PJ, Suarez JA, Gomez LG. et al. Histoclinical basis for a new classification of hemorrhoidal disease. Dis Colon Rectum 1988; 31: 474-480 DOI: 10.1007/BF02552621.
• 6 Thomson WH. The nature of haemorrhoids. Br J Surg 1975; 62: 542-552 DOI: 10.1002/bjs.1800620710.
• 7 Aigner F, Bodner G, Gruber H. et al. The vascular nature of hemorrhoids. J Gastrointest Surg 2006; 10: 1044-1050 DOI: 10.1016/j.gassur.2005.12.004.
• 8 Han W, Wang ZJ, Zhao B. et al. [Pathologic change of elastic fibers with difference of microvessel density and expression of angiogenesis-related proteins in internal hemorrhoid tissues]. Zhonghua Wei Chang Wai Ke Za Zhi 2005; 8: 56-59
• 9 Kronberger IE. Pathogenese des Hämorrhoidalleidens. coloproctology 2018; 40: 247-250 DOI: 10.1007/s00053-018-0265-5.
• 10 Yoon SO, Park SJ, Yun CH. et al. Roles of matrix metalloproteinases in tumor metastasis and angiogenesis. J Biochem Mol Biol 2003; 36: 128-137 DOI: 10.5483/bmbrep.2003.36.1.128.
• 11 Goligher JC, Duthie HL, Nixon HH. Surgery of the anus, rectum, and colon. 3rd ed.. London: Baillière Tindall; 1975
• 12 Joos AAR, Borschitz T, Brand J. et al. S3-Leitlinie-Hämorrhoidalleiden. AWMF Online 2019. p. www.awmf.org
• 13 Al-Ghnaniem R, Leather AJ, Rennie JA. Survey of methods of treatment of haemorrhoids and complications of injection sclerotherapy. Ann R Coll Surg Engl 2001; 83: 325-328
• 14 Kanellos I, Goulimaris I, Christoforidis E. et al. A comparison of the simultaneous application of sclerotherapy and rubber band ligation, with sclerotherapy and rubber band ligation applied separately, for the treatment of haemorrhoids: a prospective randomized trial. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland 2003; 5: 133-138 DOI: 10.1046/j.1463-1318.2003.00395.x.
• 15 Lu LY, Zhu Y, Sun Q. A retrospective analysis of short and long term efficacy of RBL for hemorrhoids. Eur Rev Med Pharmacol Sci 2013; 17: 2827-2830
• 16 Su MY, Chiu CT, Lin WP. et al. Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids. World J Gastroenterol 2011; 17: 2431-2436 DOI: 10.3748/wjg.v17.i19.2431.
• 17 Kraemer M, Bussen D, Leppert R. et al. [Country-wide survey of therapeutic procedures in hemorrhoids and anal fissure]. Chirurg 1998; 69: 215-218 DOI: 10.1007/s001040050401.
• 18 Beattie, Lam, Loudon. A prospective evaluation of the introduction of circumferential stapled anoplasty in the management of haemorrhoids and mucosal prolapse. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland 2000; 2: 137-142 DOI: 10.1046/j.1463-1318.2000.00125.x.
• 19 Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 1995; 90: 610-613
• 20 Laubert T, Kahlke V. Hämorrhoidenoperation. coloproctology 2020; 42: 30-36 DOI: 10.1007/s00053-019-00415-x.
• 21 Galkin EV. [Interventional radiology of chronic hemorrhoids]. Vestnik rentgenologii i radiologii 1994; 4: 52-56
• 22 Vidal V, Louis G, Bartoli JM. et al. Embolization of the hemorrhoidal arteries (the emborrhoid technique): a new concept and challenge for interventional radiology. Diagn Interv Imaging 2014; 95: 307-315 DOI: 10.1016/j.diii.2014.01.016.
• 23 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: 72-78 DOI: 10.1007/s00270-014-1017-8.
• 24 Moussa N, Sielezneff I, Sapoval M. et al. Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland 2017; 19: 194-199 DOI: 10.1111/codi.13430.
• 25 Tradi F, Louis G, Giorgi R. et al. Embolization of the Superior Rectal Arteries for Hemorrhoidal Disease: Prospective Results in 25 Patients. Journal of Vascular and Interventional Radiology 2018; 29: 884-892.e1 DOI: 10.1016/j.jvir.2018.01.778.
• 26 Zakharchenko A, Kaitoukov Y, Vinnik Y. et al. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging 2016; 97: 1079-1084 DOI: 10.1016/j.diii.2016.08.002.
• 27 Moggia E, Talamo G, Gallo G. et al. Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients. Reviews on recent clinical trials 2020; DOI: 10.2174/1574887115666200313102246.