To evaluate the safety and efficacy of outpatient transarterial embolization for symptomatic refractory internal hemorrhoids.
Materials and Methods:
150 patients with symptomatic bleeding internal hemorrhoids refractory to prior treatment were treated with Hemorrhoidal Artery Embolization (HAE) between August 2021 and June 2022 (84 males and 66 females). The average age was 54.6 years, with an average Goligher's hemorrhoid grade (HG) of 2.1. Patients underwent superior and/or middle rectal artery embolization to the target arteries demonstrating abnormal vascular blush of the hemorrhoidal cushion with spherical particles (600 micron) and/or microcoils (2-6 mm). Patients were discharged the same day and evaluated at baseline, 1-, and 3-months for the following standardized outcomes: hemorrhoid-related pain (HRP, 0-10), hemorrhoid symptoms score (HSS, 5-20), quality of life (QoL, 0-4), French bleeding score (FBS, 0-9), and HG (0-4). Clinical success was defined as symptom improvement with no need for re-intervention.
Technical success was achieved in 149/150 patients (99%). The average number of SRA branches embolized per patient was 2.9 +/- 1.0. Clinical success was seen in 93.3% (140/150) of patients at 1-month follow-up after the procedure, with 10 patients requiring repeat embolization. Secondary assisted clinical success was 99% (149/150). Significant improvements were demonstrated for all measures outcomes at 1 month: HSS (11 to 7.6, p < 0.01), HRP (4.4 to 1.3, p < 0.01), QoL (2.1 to 0.8, p < 0.01), FBS (4.4 to 2.3, p < 0.01), and HG (2.3 to 1.2, p < 0.05). Two adverse events were reported and resolved by 30 days post-procedure.
Hemorrhoidal artery embolization is a safe and effective outpatient treatment for refractory symptomatic internal hemorrhoids.