The embolization of the superior rectal arteries, a procedure termed emborrhoid, has recently been shown to be effective in haemorrhoidal disease for patients who were treated on a compassionate basis.
A group from Marseille, France led by Vincent Vidal, Department of Radiology, Hôpital de la Timone, reported the mid-term results of the first study of embolization of the superior rectal arteries as a first-line treatment for patients suffering from haemorrhoidal disease at CIRSE.
Vidal and colleagues reported in early 2015 in the journal CardioVascular and Interventional Radiology (CVIR) that the emborrhoid technique was modelled on the elective transanal Doppler-guided hemorrhoidal artery ligation which had been shown to be effective in haemorrhoidal disease.
The investigators embolized 26 patients (30 to 72 years old) with symptoms chronic, disabling rectal bleeding and/or pain after multidisciplinary discussion between a proctologist, general surgeon and radiologist.
The researchers embolized the terminal branches of the superior rectal arteries via the inferior mesenteric artery using a microcatheter and coils (0.018”, 2mm and 3mm in diameter).
Vidal and colleagues achieved a 100% technical success with the procedure. They defined clinical success as the lack of bleeding and/or pain, or insignificant amounts of bleeding and/or pain that was well-tolerated by the patients at six months as 81.8% (5/26). Four of these five patients who did not have a clinically successful outcome described amelioration of the symptoms and of the quality of life but with residual pain. One patient, who experienced re-bleeding, underwent an additional embolization of the posterior rectal arteries with success. There were no ischaemic complications observed in any of the patients.
“We believe that rectal bleeding and pain occur when venous haemorrhoidal pressure reaches a certain threshold. Embolization may decrease the arterial flow significantly, leading to a decrease of the venous pressure below this threshold. This hypothesis may explain the positive clinical results observed with this treatment,” said Vidal.
“In order to validate the emborrhoid technique, we have to conduct a randomised, prospective, multicentre study to compare emborrhoid with Doppler-guided haemorrhoidal artery ligation. We are currently working on this study, and hope to begin next year,” Vidal told Interventional News.