Hemorrhoidal artery embolization
Hemorrhoidal artery embolization (HAE, or hemorrhoid artery embolization) is a non-surgical treatment of internal hemorrhoids.[1]
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
[edit]HAE begins following the administration of local anesthesia and conscious sedation. A catheter is inserted into the femoral 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
[edit]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]
Potential adverse events
[edit]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]
References
[edit]- ^ a b "Hemorrhoidal Artery Embolization (HAE)". www.uclahealth.org. Retrieved 2024-07-17.
- ^ a b c d e Panneau, Julien; Mege, Diane; Di Biseglie, Mathieu; Duclos, Julie; Habert, Paul; Bartoli, Axel; Vidal, Vincent; Tradi, Farouk (2022). "Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques". RadioGraphics. 42 (6): 1829–1844. doi:10.1148/rg.220014. ISSN 0271-5333. PMID 36190848.
- ^ a b UCLA Health (2024-06-24). Hemorrhoidal Artery Embolization Minimally Invasive Treatment for Symptomatic Internal Hemorrhoids. Retrieved 2024-07-17 – via YouTube.
- ^ a b Zakharchenko, A.; Kaitoukov, Y.; Vinnik, Y.; Tradi, F.; Sapoval, M.; Sielezneff, I.; Galkin, E.; Vidal, V. (November 2016). "Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique)". Diagnostic and Interventional Imaging. 97 (11): 1079–1084. doi:10.1016/j.diii.2016.08.002. PMID 27597728.
- ^ a b Falsarella, Priscila Mina; Nasser, Felipe; Affonso, Breno Boueri; Galastri, Francisco Leonardo; Motta-Leal-Filho, Joaquim Mauricio da; Valle, Leonardo Guedes Moreira; Cunha, Marcela Juliano Silva; Araújo, Sergio Eduardo Alonso; Garcia, Rodrigo Gobbo; Katz, Marcelo (May 2023). "Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial". Journal of Vascular and Interventional Radiology. 34 (5): 736–744.e1. doi:10.1016/j.jvir.2023.01.022. PMID 36736690.
- ^ Moussa, N.; Bonnet, B.; Pereira, H.; Pechmajou, L.; Pellerin, O.; Abed, A.; del Giudice, C.; Dean, C.; Bouda, D.; de Parades, V.; Fathallah, N.; Sapoval, M. (July 2020). "Mid-Term Results of Superior Rectal Artery and Coils for Hemorrhoidal Embolization with Particles Bleeding". CardioVascular and Interventional Radiology. 43 (7): 1062–1069. doi:10.1007/s00270-020-02441-5. ISSN 0174-1551. PMID 32342155.
- ^ Bagla, Sandeep; Pavidapha, Alex; Lerner, Jade; Kasimcan, Mustafa O.; Piechowiak, Rachel; Josovitz, Kenneth; Marathe, Atul; Isaacson, Ari; Sajan, Abin (May 2023). "Outcomes of Hemorrhoidal Artery Embolization from a Multidisciplinary Outpatient Interventional Center". Journal of Vascular and Interventional Radiology. 34 (5): 745–749. doi:10.1016/j.jvir.2023.01.023. ISSN 1051-0443. PMID 36736822.
- ^ De Gregorio, Miguel A.; Guirola, Jose A.; Serrano-Casorran, Carolina; Urbano, José; Gutiérrez, Carolina; Gregorio, Abel; Sierre, Sergio; Ciampi-Dopazo, Juan Jose; Bernal, Roman; Gil, Ismael; De Blas, Ignacio; Sánchez-Ballestín, Maria; Millera, Alfonso (2023-07-17). "Catheter-directed hemorrhoidal embolization for rectal bleeding due to hemorrhoids (Goligher grade I–III): prospective outcomes from a Spanish emborrhoid registry". European Radiology. 33 (12): 8754–8763. doi:10.1007/s00330-023-09923-3. ISSN 1432-1084. PMID 37458757.
- ^ Makris, Gregory C.; Thulasidasan, Narayan; Malietzis, George; Kontovounisios, Christos; Saibudeen, Affan; Uberoi, Raman; Diamantopoulos, Athanasios; Sapoval, Marc; Vidal, Vincent. "Catheter-Directed Hemorrhoidal Dearterialization Technique for the Management of Hemorrhoids: A Meta-Analysis of the Clinical Evidence". Journal of vascular and interventional radiology: JVIR. 32 (8): 1119–1127. doi:10.1016/j.jvir.2021.03.548. ISSN 1535-7732. PMID 33971251.