Embolization of Rectal Arteries for Treating Hemorrhoidal Disease Using a Combination of Microspheres and Microcoils: A Pilot Study

To investigate the feasibility and initial results of superior (SRA) and middle (MRA) rectal artery embolization for patients with symptomatic hemorrhoidal disease.

Prospective, single-center cohort that included ten consecutive patients (Goligher classification was II in 70% and III in 30%.) who underwent SRA and MRA embolization using a combination of microspheres and metallic coils, who completed a follow-up period of 12 months. Technical success was defined as embolization of SRA and MRA whenever MRA dominance was observed. Clinical success was defined as an improvement of the hemorrhoid severity score (HSS) and quality of life (QoL) scores without recurrence, with the need for additional treatment. Procedure-related adverse events (AEs) were recorded and defined according to CIRSE classification as minor or major complications.

Technical success was achieved in all patients. SRA was embolized in 100% of patients and MRA in 80%. The improvement in HSS and QoL scores was 88% and 88% (p < 0.05), respectively, without clinical recurrence in the 12-month follow-up. One patient had a major complication (level D), a rectal ischemia and perforation of the rectosigmoid leading to perforative acute abdomen with sepsis that required surgical treatment (Hartmann’s procedure).

Embolization of both SRA-MRA using a combination of microspheres and metallic coils was feasible and significantly improved HSS and QoL scores. One major complication was observed and therefore it is essential to further investigate the safety boundaries of this technique.