title: Embolization of the superior rectal arteries for chronic bleeding due to haemorrhoidal disease.
abstract: OBJECTIVE
  The aim of this study was to assess the safety and efficacy of the emborrhoid technique (embolization of the superior haemorrhoidal arteries) in patients ineligible for surgery.
  
  
  METHODS
  Between January 2014 and April 2015, 30 consecutive patients (average age 58 years) suffering from disabling chronic bleeding due to haemorrhoidal disease and with a contraindication for surgery (n = 23) or with a failure of instrumental or surgical treatment (n = 7) underwent embolization. All cases were discussed at multidisciplinary meetings including a proctology specialist or a surgeon and an interventional radiologist. We performed super selective micro coil embolization (pushable 2-3 mm fibre coils) of the distal branches of the superior rectal arteries with a microcatheter, via a right femoral approach, under local anaesthesia. We assessed clinical outcome by evaluating bleeding and specific clinical scores relating to bleeding and changes in quality of life.
  
  
  RESULTS
  Immediate technical success, with no complication, was achieved in 93% of cases. A mean of 3.1 arteries per patient was embolized, with a mean of 7.6 coils per patient. Median follow-up was 5 months. Clinical score improvement was observed in 72%, in 17 patients after a single embolization session, and in four additional patients after a second embolization session. No improvement in bleeding was observed in eight patients (28%).
  
  
  CONCLUSIONS
  Distal coil embolization of the superior rectal arteries for disabling chronic bleeding due to haemorrhoidal disease is safe and effective in patients untreatable by surgery.
authors.affiliation: Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.|Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Moussa
authors.affiliation: Department of Digestive and General Surgery, La Timone Hospital, Marseille, France.|Aix-Marseille University, Marseille, France.|INSERM, UMR-S 1076 VRCM (Vascular Research Centre of Marseille), Marseille, France.
authors.forename: I
authors.initials: I
authors.lastname: Sielezneff
authors.affiliation: Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.|Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.|INSERM U970, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Sapoval
authors.affiliation: Aix-Marseille University, Marseille, France.|Department of Radiology, La Timone Hospital, Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Tradi
authors.affiliation: Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.|Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Del Giudice
authors.affiliation: Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.|Assistance Publique - Hôpitaux de Paris, Georges Pompidou European Hospital, Gastro-enterology Department, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Fathallah
authors.affiliation: Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.|Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.|INSERM U970, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Pellerin
authors.affiliation: Sorbonne Paris Cité, Medicine Faculty, Paris Descartes University, Paris, France.|Assistance Publique - Hôpitaux de Paris, Interventional Radiology Department, Georges Pompidou European Hospital, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Amouyal
authors.affiliation: Assistance Publique - Hôpitaux de Paris, Georges Pompidou European Hospital, Unité d'Épidémiologie et de Recherche Clinique, Paris, France.|INSERM, Centre d'Investigation Clinique 1418, Module d'Épidémiologie Clinique, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Pereira
authors.affiliation: Department of Proctology, Saint Joseph Hospital, Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: de Parades
authors.affiliation: Aix-Marseille University, Marseille, France.|Department of Radiology, La Timone Hospital, Marseille, France.
authors.forename: V
authors.initials: V
authors.lastname: Vidal
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006484:Hemorrhoids / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D017537:Mesenteric Artery, Inferior; D008875:Middle Aged; D012007:Rectum / Q000098:blood supply*
keywords: Interventional radiology; chronic bleeding; embolization; haemorrhoids; inferior mesenteric artery