Safety and efficacy of superior rectal artery embolization with particles and metallic coils for the treatment of hemorrhoids (Emborrhoid technique).
OBJECTIVE
The purpose of this study was to comprehensively evaluate the short-term outcomes after percutaneous embolization of the superior rectal artery (SRA) with metallic coils and particles for the management of hemorrhoids.


METHODS
Forty patients (15 men, 25 women) with a mean age of 35±5 years (SD) (range: 25-65 years) were prospectively enrolled. All patients had symptomatic hemorrhoids. The distribution of internal hemorrhoids was as follows: grade I (n=6, 16%); grade II (n=28, 69%) and grade III (n=6; 15%). All patients had percutaneous embolization of the SRA with metallic coils and synthetic polyvinyl alcohol particles. Follow-up evaluation included clinical examination, rectoscopy, histopathological analysis of rectal mucosa, duplex Doppler blood flow quantification, electromyography, sphincterometry of the anal sphincter and analysis of patient satisfaction.


RESULTS
No immediate complications were observed and no patients had anal pain syndrome after embolization. Hemorrhoids showed a 43% size reduction after embolization (P<0.05). Taking into account the symptom resolutions such as irritation, discomfort, bloody discharge and pain, satisfaction was observed in 5/6 (83%) patients with grade III hemorrhoids and 32/34 patients (94%) with grades I-II hemorrhoids. One month after embolization, anal sphincter contractility normalized and no changes in anal electromyography were observed. Blood flow in the hemorrhoidal plexus dropped from 109±1.2ml/min/100g (SD) before treatment to 60.2±4.4ml/min/100g (SD) (P<0.05) the day after embolization and remained unchanged one month after embolization.


CONCLUSIONS
Our study demonstrates that embolization of SRA with particle and coils does not lead to ischemia in patients with symptomatic hemorrhoids. Short-term results with regard to symptom management for hemorrhoidal disease are very encouraging and should stimulate further prospective and multicenter studies.
Department of general surgery, Krasnoyarsk state medical university, Krasnoyarsk Railwey clinical hospital, Krasnoyarsk, Russia.
A
A
Zakharchenko
Department of diagnostic radiology and radio-oncology, centre hospitalier de l'université de Montréal, Montreal, Canada.
Y
Y
Kaitoukov
Department of general surgery, Krasnoyarsk state medical university, Krasnoyarsk Railwey clinical hospital, Krasnoyarsk, Russia.
Y
Y
Vinnik
Department of vascular and interventional radiology, hôpital de la Timone, 13005 Marseille, France.
F
F
Tradi
Department of interventional radiology, hôpital Georges-Pompidou, 75015 Paris, France.
M
M
Sapoval
Department of visceral surgery, Aix-Marseille university, hôpital de la Timone, 13005 Marseille, France.
I
I
Sielezneff
Department of vascular surgery and interventional radiology, Siberian clinical center FMBA, Krasnoyarsk, Russia.
E
E
Galkin
Department of vascular and interventional radiology, hôpital de la Timone, 13005 Marseille, France. Electronic address: vincent.vidal@ap-hm.fr.
V
V
Vidal
D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012007:Rectum / Q000098:blood supply*; D016896:Treatment Outcome
Emborrhoid; Hemorrhoids; Interventional imaging; Percutaneous arterial embolization; Rectal artery