Hemorrhoid Embolization

Background and indications

Hemorrhoidal disease affects nearly 50% of the population over 50. Symptomatic internal hemorrhoids mainly present as recurrent rectal bleeding, sometimes causing iron-deficiency anemia. Superior rectal artery embolization (the "Emborrhoid" technique) is a minimally invasive alternative to instrumental treatments (rubber band ligation, infrared photocoagulation) and surgery (hemorrhoidectomy, hemorrhoidopexy) for grade II to IV hemorrhoids with predominantly bleeding symptoms.

This technique is particularly indicated for patients on anticoagulants or antiplatelet agents, patients with high surgical risk, or those wishing to avoid the pain and prolonged recovery of surgery.

Pre-procedure assessment

Assessment includes a proctological consultation with anoscopy confirming the diagnosis and hemorrhoid grade, colonoscopy (recommended after age 45-50 to exclude other causes of bleeding), and blood tests including complete blood count (screening for anemia) and coagulation panel.

Procedure

Under local anesthesia and light sedation, a microcatheter is introduced through the femoral artery at the groin. Under fluoroscopic guidance, the interventional radiologist selectively catheterizes the inferior mesenteric artery then the branches of the superior rectal artery feeding the hemorrhoidal plexuses. Embolization is performed using microcoils and/or microparticles. Cone-beam CT may be used to verify proper artery targeting. The procedure takes approximately 30 to 60 minutes and is painless (no sensory innervation in the embolized territory).

Results and scientific evidence

A prospective study of 134 patients demonstrated a 93% clinical success rate for hemorrhoidal bleeding after embolization, with a mean follow-up of 16 months (Journal of Vascular and Interventional Radiology, 2023; DOI: 10.1016/j.jvir.2023.01.023). Technical success rate exceeds 95%.

More recent series of over 200 patients confirm a clinical improvement rate of 85-93%, with a 10-15% recurrence rate at 2 years. Patient satisfaction rate is high (> 90%), mainly due to the absence of post-procedural pain and rapid return to activities.

Risks and complications

Complications are rare and minor: mild pain at the femoral puncture site (< 5%), transient pelvic discomfort (< 3%). There is no anal wound, no anal canal pain, and no risk of anal incontinence. Major complications (non-target embolization, rectal ischemia) are exceptional (< 0.5%) thanks to super-selective catheterization.

Recovery

Recovery is immediate: most patients resume normal activities the following day. There are no dietary restrictions or local care required. Bleeding improvement is observed within the first weeks. Follow-up is scheduled at 1, 3, and 6 months.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by an interventional radiologist, in coordination with the treating gastroenterologist or proctologist.