[Treatment of hemorrhoids with rectal artery embolization].

Abstract

Introduction: Hemorrhoids are the most common anorectal diseases, with a prevalence of 4–35%. Endovascular treatment of hemorrhoid patients was first performed in 2014, and since then the evidence for this intervention has been confirmed by numerous reviews and meta-analyses. Objective: We were the first in Hungary to start using this treatment. In our publication, we present the arterial blood supply of hemorrhoids, the causes of their development, pathophysiology, conservative, surgical and endovascular treatment. We present the technical details of superior rectal artery embolization. In addition to the radiological and clinical results of our first 15 treated patients, we present the literature and evidence of the treatment procedure. Method: The analysis of our clinical study was performed based on a prospective clinical design and with ethical approval. According to Goligher classification, 20% of our patients were in stage 2 and 80% were in stage 3 of the disease before the intervention. 80% of our patients had pain, 80% had bleeding, and a third had itching and discomfort due to their hemorrhoids. One patient was treated for very severe anemia and one patient for severe anemia. In our angiography laboratory, we performed superselective embolization of the superior mesenteric artery branches with hairy coils under local anesthesia from a femoral puncture. Results: All our interventions were technically successful, and no complications were observed in any case. The average value on the basis of the hemorrhoidal bleeding scale during early control was 0.23 and the average value was 0.23 during the 12-week control. Out of 15 patients, 14 became completely asymptomatic and complaint-free, and 1 patient’s hemorrhoidal bleeding scale value decreased from 6 to 3 during the follow-up. Discussion: The advantage of endovascular intervention is that it is painless, complication-free and can be performed as a one-day procedure without anesthesia. Patients can live a full life from the day after the intervention. Our technical and clinical results achieved during the treatment of our first 15 patients show similar success rates to international results. Conclusion: Superior rectal artery embolization is a minimally invasive procedure that is considered an alternative to surgical procedures in the treatment of grade 2 and 3 hemorrhoidal disease. Orv Hetil. 2025; 166(26): 1025–1030.