Radiología (English Edition)

Radiología (English Edition)

Volume 62, Issue 4, July–August 2020, Pages 313-319
Radiología (English Edition)

Original article
Selective intra-arterial embolisation to treat haemorrhoidsEmbolización intraarterial selectiva como tratamiento de la patología hemorroidal

https://doi.org/10.1016/j.rxeng.2020.03.008Get rights and content

Abstract

Objective

To present our results and describe the technique used for the endovascular treatment of haemorrhoids.

Material and methods

We used right femoral artery or radial artery access to catheterize the inferior mesenteric artery, proceeding to the superior rectal artery with a 2.7F microcatheter to catheterize and embolise each distal branch distally with PVA particles (300–500 μm) and proximally with coils (2–3 mm). Patients were discharged 24 h after the procedure and clinically followed up at one month by anoscopy.

Results

We included 20 patients (4 women and 16 men); mean age, 61.85 years (27–81 years); mean follow-up, 10.6 months (28–2 months). Technical success was achieved in 18 (90%) patients and clinical success in 15 (83.4%); one patient required a second embolisation of the medial rectal artery and two required surgery. Recovery was practically painless. At the one-month follow-up, all patients were very satisfied and anoscopy demonstrated marked improvement of the haemorrhoids. There were no complications secondary to embolisation.

Conclusions

Our initial results suggest that selective intra-arterial embolisation is a safe and painless procedure that is well tolerated because it avoids rectal trauma and patients recover immediately.

Resumen

Objetivo

El objetivo de este trabajo es presentar nuestros resultados, describiendo la técnica utilizada en el tratamiento endovascular de las hemorroides.

Material y Método

La embolización se realizó mediante punción de la arteria femoral derecha o vía arteria radial, y se cateterizó la arteria mesentérica inferior (AMI) accediéndose a la arteria rectal superior con un microcatéter (2,7 F) con el que cateterizábamos cada rama distal, ocluyéndolas distalmente con partículas de PVA (300-500 micras), y proximalmente con coils de 2-3 mm. Los pacientes recibieron el alta a las 24 horas, al mes se les evaluó clínicamente y se les realizó una anoscopia.

Resultados

El estudio incluye 20 pacientes. (4 mujeres y 16 hombres), edad media de 61,85 años (27-81), con seguimiento medio de 10,6 meses (rango de 28-2 meses). El éxito técnico fue del 90% (18/20) y el éxito clínico de 83,4% (15/18); un paciente requirió nueva embolización de la arteria rectal media y dos pacientes requirieron cirugía. La recuperación fue prácticamente indolora. Al mes todos referían gran satisfacción y la anoscopia demostraba importante mejoría de las hemorroides. No hubo complicaciones secundarias a la embolización.

Conclusiones

Los resultados iniciales sugieren que la ESARS es un procedimiento seguro e indoloro, bien tolerado que evita el trauma anorrectal, y recuperación inmediata del paciente.

Introduction

Haemorrhoidal disease is currently the most common anorectal disorder, with a prevalence of 4%–35% of the population. In most cases it manifests as varying degrees of rectal bleeding, with only 10% requiring surgical treatment.1

Up to now, the reference surgical technique has been the Milligan–Morgan technique, which is essentially open haemorrhoidectomy.2 Since 1990 there have been descriptions in the scientific literature of new surgical techniques aimed at reducing post-surgical pain and achieving complete recovery of the patient in less time. The circular anopexia described by Longo3 reduces the number of days in hospital and the pain is less intense. However, the reported recurrence rates are as high as 15–20% of cases.4

Among the non-excision surgical techniques, ligation of the haemorrhoidal arteries in the distal rectum by Doppler-guided transanal haemorrhoidal dearterialisation (THD Doppler procedure) is associated with less postoperative pain compared to classic surgical techniques and without adverse events in terms of postoperative complications.5, 6

The development of interventional endovascular techniques offers the chance to perform intra-arterial embolisations (IAE) to occlude the superior rectal artery. The advantages of this intra-arterial embolisation technique over transanal haemorrhoidal dearterialisation include the fact that all branches dependent on the superior rectal artery can be identified and therefore embolised, and it is even possible to occlude any anastomoses with the middle rectal artery, thereby removing the risk of rectal trauma.7, 8 Coil embolisation of the superior rectal artery is a well tolerated, effective and safe technique.9, 10

The aim of this paper is to present our results, describing the technique used in the endovascular treatment of haemorrhoids.

Section snippets

Material and methods

This was a retrospective observational study conducted in our hospital and approved by the Research Committee. Informed consent was obtained from each patient.

From September 2017 to April 2019, we included 20 patients with grade II or III haemorrhoidal disease visualised by anoscope or proctoscope, accompanied by significant rectal bleeding (Table 1).

The patients attended the colorectal surgery outpatient clinic, where their medical history was taken and the examination performed. Patients who

Results

The study included 20 symptomatic patients (16 males and 4 females) with grade II and III bleeding haemorrhoids and a mean age of 61.85 (27–81). Two patients had previously undergone haemorrhoidectomy.

The technical success of embolisation of the superior rectal artery was obtained in 18 (90%) of the 20 patients. Clinical success was achieved in 15 (83.4%) out of 18, as one patient required a further embolisation due to recurrence of bleeding and two patients had acute bleeding one month later,

Discussion

In recent years, the published results on the endovascular treatment of haemorrhoids suggest a very encouraging alternative to conventional surgery.8, 9, 11, 12 The findings and results of our study corroborate the benefits of using this procedure, as an end to rectal bleeding is achieved in a high percentage of cases and the postoperative period is virtually painless.

Haemorrhoids are classified into internal and external haemorrhoids according to their location above or below the dentate line.

Authorship

  • 1.

    Responsible for the integrity of the study: MDFP, EEH, FJBG, RRG and JSS.

  • 2.

    Study conception: MDFP, EEH, FJBG, RRG and JSS.

  • 3.

    Study design: MDFP, EEH, FJBG, RRG and JSS.

  • 4.

    Data acquisition: MDFP, EEH, FJBG, RRG and JSS.

  • 5.

    Data analysis and interpretation: MDFP, EEH, FJBG, RRG and JSS.

  • 6.

    Statistical processing:

  • 7.

    Literature search: MDFP, EEH and JSS.

  • 8.

    Drafting of the article: MDFP, EEH and FJBG.

  • 9.

    Critical review of the manuscript with intellectually relevant contributions: MDFP, EEH, FJBG, RRG and JSS.

  • 10.

    Approval of the

Funding

There has been no source of funding for this manuscript.

Conflict of interest

The authors declare that they have no conflicts of interest.

References (15)

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Cited by (0)

Please cite this article as: Ferrer Puchol MD, Esteban Hernández E, Blanco González FJ, Ramiro Gandia R, Solaz Solaz J, Pacheco Usmayo A. Embolización intraarterial selectiva como tratamiento de la patología hemorroidal. Radiología. 2020. https://doi.org/10.1016/j.rx.2019.12.004

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