Hemorrhoidal artery embolization

Hemorrhoidal artery embolization (HAE, or hemorrhoid embolization) is a non-surgical treatment of internal hemorrhoids.^[1]

Hemorrhoids before and after hemorrhoidal artery embolization

The procedure involves blocking the abnormal blood flow to the rectal (hemorrhoidal) arteries using microcoils and/or microparticles to decrease the size of the hemorrhoids and improve hemorrhoid related symptoms, especially bleeding.^[2] It is a minimally invasive therapy that can be performed as an outpatient procedure.^[3]

Procedure

HAE begins when a catheter is inserted into the femoral or radial artery through a small incision. The catheter is then carefully navigated through the arterial system with x-ray guidance until it reaches the branches of the superior rectal artery that supply blood to the hemorrhoidal plexus.^[3] Once in position, microparticles and/or microcoils are injected through the catheter to block these arteries, thereby reducing the blood supply to the hemorrhoids. This causes the hemorrhoidal tissue to shrink over time, alleviating symptoms such as pain, bleeding, and swelling.^[1][2][4] Post-procedure, patients are monitored for a brief period to ensure stability before being discharged with instructions for managing any minor discomfort or symptoms that may occur during the recovery period.

Benefits

HAE offers several benefits as a minimally invasive treatment for symptomatic hemorrhoids. Firstly, HAE effectively reduces blood flow to the hemorrhoidal tissue, leading to significant shrinkage and resolution of symptoms such as pain, bleeding, and prolapse.^[2][4] This approach has been shown to provide long-lasting relief comparable to surgical methods but with potentially lower complication rates and faster recovery times.^[5] Additionally, HAE is associated with minimal post-procedural pain and allows for quicker return to daily activities, making it an attractive option for patients seeking less invasive treatment options.^[5] Moreover, its safety profile and efficacy have been supported by clinical trials, demonstrating its potential as a preferred alternative for managing hemorrhoidal disease.^[6][7][8] HAE is very effective at stopping bleeding related symptom with success rate of approximately 90%.^[9]

Post-procedural care

Following hemorrhoidal artery embolization, patients are generally monitored both during their hospital stay and after discharge. The interventional radiologist and medical team may conduct regular follow-ups, often through scheduled phone calls or check-ins, to evaluate recovery and ensure the patient is returning to normal health. This ongoing care is intended to promote a safe and effective recovery process.^[10]

Potential adverse events

The incidence of adverse events with HAE is very low. Rare arterial access site complications may occur.^[2] Although minor anal discomfort can occur in a minority of patients, there have been no reports of anorectal complications when embolization is performed primarily with microcoils.^[2] Overall, the frequency and severity of any potential adverse events are significantly lower in HAE compared to surgery or transanal procedures.^[11]

Future prospects

Hemorrhoidal artery coil embolization is considered a minimally invasive and relatively painless technique, often performed on an outpatient basis due to the absence of direct anorectal trauma. It may also be a suitable option for patients requiring compassionate care or those with contraindications to surgery. These features highlight the potential of the emborrhoid technique as a promising alternative for hemorrhoid treatment. However, further validation through randomized controlled trials is necessary to confirm its long-term effectiveness and safety.^[12]