1. Treatment of hemorrhoids by selective embolization of the superior rectal arteries (SRA): initial experience.
Primo, V. (1); Gregorio, A. (2); Andreo, L.(2); De La Morena, E. (1)
(1) Hospital de Dénia, Marina-salud, General surgery, Dénia, Spain
(2) Hospital de Dénia, Marina-salud, Radiology, Dénia, Spain
AIM
To assess our experience in the treatment of hemorrhoids by selective embolization of the superior rectal arteries (SRA) as an alternative treatment option in patients considered unsuitable for surgical intervention.
METHOD:
We present three patients with inflammatory bowel disease (IBD), with grade III hemorrhoid associated to rectal bleeding, proctalgia and prolapse. In these cases, surgery has limitations due to associated complications. Patients underwent SRA embolization with " microcoils (Interlock®, Boston) using femoral artery approach. This technique does not involve surgical maneuvers that may involve anorectal trauma, avoiding risk of bleeding, fissures, stenosis and incontinence.
Inferior mesenteric artery arteriography: sigmoid artery branches (white arrow), Superior rectal artery branches (black arrows).
RESULTS:
Preliminary results show that this is a safe treatment option. The pain analyzed according to visual analog scale at 24 hours was 0 (two patients) and 3. No prolapse, immediate rectal bleeding or ischemic complications were observed. At the 3-month review, two patients showed significant improvement of rectal bleeding. The third patient has continued to present autolimited rectal bleeding, pending new embolization.
Postembolization control. Coils in ocluded vessels (white arrows), remanent open branches (black arrows).
CONCLUSION:
Our data do not allow conclusions to be drawn, however SRA seems to be a safe treatment option in patients where surgery is restricted. Greater sample and clinical trials are required to extract long-term results