Abstract
Objectives
To compare safety and clinical outcomes of embolization of the superior rectal arteries in patients with hemorrhoidal bleeding using particles and coils versus coils only.
Methods
We retrospectively reviewed data for patients undergoing embolization for chronic hemorrhoidal bleeding from January 2014 to April 2017. Embolization was performed with coils alone or with particles and coils. Clinical scores (Paris bleeding severity score, Goligher classification and quality of life score) were obtained, and embolization was performed with microparticles (300–500 μm) followed by fibered pushable coils. Clinical success was defined as an improvement of > 2 points in the Paris bleeding severity score, without complications. Outcomes were compared between the two groups in a matched-pairs analysis (1:1 scenario), with patients embolized with particles and coils as the study group and patients embolized with coils alone as the control.
Results
We treated 45 consecutive patients. After matched-pairs analysis, the final study population was 38 patients (19 study group and 19 controls). Clinical success did not differ significantly between the two populations: 63% for control group and 68% for the study group (p = 0.790). The median change in clinical score was − 3 [− 6; − 1] for the control group and − 3 [− 4; − 1] for the study group (p = 0.187). Grade 1 complications were reported in 15% of patients, with no major complications.
Conclusions
Embolization was feasible, with a technical success of 100% and no major complications. Clinical success was obtained in 66% in patients with no difference when using combined embolization with particles and coils versus coils only.
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Abbreviations
- DG-HAL:
-
Doppler-guided hemorrhoidal artery ligation
- N:
-
Number
- SD:
-
Standard deviations
- IQR:
-
Interquartile ranges
- QOL:
-
Quality of life
- PDS:
-
Dose area product
References
Aigner F, Bodner G, Gruber H, et al. The vascular nature of hemorrhoids. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2006;10:1044–50. https://doi.org/10.1016/j.gassur.2005.12.004.
Vidal V, Louis G, Bartoli JM, Sielezneff I. Embolization of the hemorrhoidal arteries (the emborrhoid technique): a new concept and challenge for interventional radiology. Diagn Interv Imaging. 2014;95:307–15. https://doi.org/10.1016/j.diii.2014.01.016.
Vidal V, Sapoval M, Sielezneff Y, et al. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases. Cardiovasc Intervent Radiol. 2014. https://doi.org/10.1007/s00270-014-1017-8.
Moussa N, Sielezneff I, Sapoval M, et al. Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease. Colorectal Dis Off J Assoc Coloproctology G B Irel 2017;19:194–99. https://doi.org/10.1111/codi.13430.
Tradi F, Louis G, Giorgi R, et al. Embolization of the superior rectal arteries for hemorrhoidal disease: prospective results in 25 patients. J Vasc Interv Radiol JVIR. 2018;29:884–92. https://doi.org/10.1016/j.jvir.2018.01.778.
Pearce N. Analysis of matched case-control studies. BMJ. 2016;352:i969.
Filippiadis DK, Binkert C, Pellerin O, et al. Cirse Quality Assurance Document and Standards for Classification of Complications: the Cirse Classification System. Cardiovasc Intervent Radiol. 2017;40:1141–6. https://doi.org/10.1007/s00270-017-1703-4.
Zakharchenko A, Kaitoukov Y, Vinnik Y, et al. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging. 2016;97:1079–84. https://doi.org/10.1016/j.diii.2016.08.002.
Parnaud E, Guntz M, Bidart JM, Bernard A, Chome J. Considération sur la vascularisation normale de la sous muqueuse anale. Rev Proct. 1981;1:44–54.
Aigner F, Gruber H, Conrad F, et al. Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Colorectal Dis. 2009;24:105–13. https://doi.org/10.1007/s00384-008-0572-3.
Sun X, Xu J, Zhang J, et al. Management of rectal bleeding due to internal haemorrhoids with arterial embolisation: a single-centre experience and protocol. Clin Radiol. 2018;73:985.e1–6. https://doi.org/10.1016/j.crad.2018.07.105.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the appropriate institutional review board.
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Moussa, N., Bonnet, B., Pereira, H. et al. Mid-Term Results of Superior Rectal Artery and Coils for Hemorrhoidal Embolization with Particles Bleeding. Cardiovasc Intervent Radiol 43, 1062–1069 (2020). https://doi.org/10.1007/s00270-020-02441-5
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DOI: https://doi.org/10.1007/s00270-020-02441-5