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Superior Rectal Artery Embolisation for Haemorrhoids: What Do We Know So Far?

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  • Embolisation (arterial
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Abstract

Haemorrhoids are abnormally enlarged anal cushions within the lower rectum. They are common, and have potential to significantly impact patients’ quality of life. Superior rectal artery embolisation is a technique which has been discussed in the literature as far back as 40 years ago. More recently, there has been interest in the role of embolisation in the treatment for haemorrhoids, as an alternative to established minimally invasive and conventional surgical techniques. In this review, we discuss the current literature on the topic, with particular focus on technique, clinical outcomes and complications. Emerging procedural and technical considerations are discussed, with further review of the role of coil vs. particle embolisation.

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References

  1. Tucker H, George E, Barnett D, Longson C. NICE technology appraisal on stapled haemorrhoidopexy for the treatment of haemorrhoids. The Royal College of Surgeons of England. 2008.

  2. 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.

    Article  CAS  Google Scholar 

  3. Vidal V, Sapoval M, Sielezneff Y, De Parades V, Tradi F, Louis G, Bartoli JM, Pellerin O. Emborrhoid: a new concept for the treatment of hemorrhoids with arterial embolization: the first 14 cases. CardioVasc Interv Radiol. 2015. https://doi.org/10.1007/s00270-014-1017-8.

    Article  Google Scholar 

  4. National Institute for Health and Care Excellence (2018) Superior rectal artery embolisation for haemorrhoids—Interventional procedure guidance IPG627. https://www.nice.org.uk/guidance/IPG627. Accessed 27 Jul 2020.

  5. Hardy A, Chan CLH, Cohen CRG. The surgical management of haemorrhoids—a review. Dig Surg. 2005. https://doi.org/10.1159/000085343.

    Article  PubMed  Google Scholar 

  6. van Tol RR, Kleijnen J, Watson AJM, Jongen J, Altomare DF, Qvist N, Higuero T, Muris JWM, Breukink SO. European Society of ColoProctology (ESCP) Guideline for Haemorrhoidal Disease. ESCP. 2020.

  7. Mahadevan V. Anatomy of the rectum and anal canal. Surg Oxford. 2017;35:121–5.

    Google Scholar 

  8. Aigner F, Bodner G, Gruber H, Conrad F, Fritsch H, Margreiter R, Bonatti H. The vascular nature of hemorrhoids. J Gastrointest Surg. 2006;10:1044–50.

    Article  Google Scholar 

  9. Bilhim T, Pereira JA, Tinto HR, Fernandes L, Duarte M, O’Neill JE, Pisco JM. Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surg Radiol Anat. 2013. https://doi.org/10.1007/s00276-012-1068-y.

    Article  PubMed  Google Scholar 

  10. Sun X, Xu J, Zhang J, Jin Y, Chen Q. Management of rectal bleeding due to internal haemorrhoids with arterial embolisation: a single-centre experience and protocol. Clin Radiol. 2018. https://doi.org/10.1016/j.crad.2018.07.105.

    Article  PubMed  Google Scholar 

  11. Tradi F, Louis G, Giorgi R, Mege D, Bartoli JM, Sielezneff I, Vidal V. Embolization of the superior rectal arteries for hemorrhoidal disease: prospective results in 25 patients. J Vasc Interv Radiol. 2018. https://doi.org/10.1016/j.jvir.2018.01.778.

    Article  PubMed  Google Scholar 

  12. Cerato MM, Cerato NL, Passos P, Treigue A, Damin DC. Surgical treatment of hemorrhoids: a critical appraisal of the current options. ABCD Arquivos Brasileiros de Cirurgia Digestiva SP. 2014;27:66–70.

    Article  Google Scholar 

  13. Rubbini M, Ascanelli S. Classification and guidelines of hemorrhoidal disease: present and future. World J Gastrointest Surg. 2019;11:117–21.

    Article  Google Scholar 

  14. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G. Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009. https://doi.org/10.1007/DCR.0b013e3181af50f4.

    Article  PubMed  Google Scholar 

  15. Pucher PH, Sodergren MH, Lord AC, Darzi A, Ziprin P. Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis. 2013. https://doi.org/10.1111/codi.12205.

    Article  PubMed  Google Scholar 

  16. Brown SR, Tiernan JP, Watson AJM, Biggs K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. The Lancet. 2016. https://doi.org/10.1016/S0140-6736(16)30584-0.

    Article  PubMed  Google Scholar 

  17. Chuang VP, Wallace S, Zornoza J, Davis LJ. Transcatheter arterial occlusion in the management of rectosigmoidal bleeding. Radiology. 1979. https://doi.org/10.1148/133.3.605.

    Article  PubMed  Google Scholar 

  18. Derodra JK, Reidy JF, Jourdan MH. Embolization of superior haemorrhoidal artery in the management of life-threatening rectal bleeding. Br J Surg. 1992. https://doi.org/10.1002/bjs.1800790738.

    Article  PubMed  Google Scholar 

  19. Dobson CC, Nicholson AA. Treatment of rectal hemorrhage by coil embolization. CardioVasc Interv Radiol. 1999. https://doi.org/10.1007/BF03035356.

    Article  Google Scholar 

  20. Pichon N, François B, Pichon-Lefièvre F, Mathonnet M, Maubon A, Vignon P. Embolization of rectal arteries: an alternative treatment for hemorrhagic shock induced by traumatic intrarectal hemorrhage. CardioVasc Interv Radiol. 2005. https://doi.org/10.1007/s00270-004-0168-4.

    Article  Google Scholar 

  21. Berczi V, Gopalan D, Cleveland TJ. Embolization of a hemorrhoid following 18 hours of life-threatening bleeding. CardioVasc Interv Radiol. 2008. https://doi.org/10.1007/s00270-006-0179-4.

    Article  Google Scholar 

  22. Tarazov PG. Arterial embolization of hemorrhoids. CardioVasc Interv Radiol. 2015. https://doi.org/10.1007/s00270-015-1148-6.

    Article  Google Scholar 

  23. Vidal V, Sapoval M, Pellerin O. Arterial embolization of hemorrhoids: reply. Cardiovasc Interv Radiol. 2015;38:1056.

    Article  CAS  Google Scholar 

  24. Moussa N, Bonnet B, Pereira H, et al. Mid-term results of superior rectal artery and coils for hemorrhoidal embolization with particles bleeding. CardioVasc Interv Radiol. 2020. https://doi.org/10.1007/s00270-020-02441-5.

    Article  Google Scholar 

  25. Moggia E, Talamo G, Gallo G, Bianco A, Barattini M, Salsano G, Zefiro D, Stefanini T, Berti S. Do we have another option to treat bleeding hemorrhoids? The Emborrhoid technique: experience in 16 patients. Reviews on recent clinical trials. 2020.

  26. Zakharchenko A, Kaitoukov Y, Vinnik Y, Tradi F, Sapoval M, Sielezneff I, Galkin E, Vidal V. Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique). Diagn Interv Imaging. 2016. https://doi.org/10.1016/j.diii.2016.08.002.

    Article  PubMed  Google Scholar 

  27. Moussa N, Sielezneff I, Sapoval M, et al. Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease. Colorectal Dis. 2017. https://doi.org/10.1111/codi.13430.

    Article  PubMed  Google Scholar 

  28. Huang C-C, Lee C-W, Hsiao J-K, Leung P-C, Liu K-L, Tsang Y-M, Liu H-M. N-butyl cyanoacrylate embolization as the primary treatment of acute hemodynamically unstable lower gastrointestinal hemorrhage. J Vasc Interv Radiol. 2011;22:1594–9.

    Article  Google Scholar 

  29. Lanza E. Transarterial coil embolization of the superior rectal arteries for treatment of stage II hemorrhoids. In: clinicaltrials.gov. https://clinicaltrials.gov/ct2/show/NCT03805087. Accessed 27 Feb 2020. 2019.

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Mert Sirakaya contributed to conceptualisation. Mert Sirakaya and Aleem O’Balogun conducted literature review. Mert Sirakaya and Aleem O’Balogun were involved in drafting. Rahil Hussein Kassamali was involved in critical appraisal, revision and supervision.

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Correspondence to Mert Sirakaya.

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Sirakaya, M., O’Balogun, A. & Kassamali, R.H. Superior Rectal Artery Embolisation for Haemorrhoids: What Do We Know So Far?. Cardiovasc Intervent Radiol 44, 675–685 (2021). https://doi.org/10.1007/s00270-020-02733-w

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