Hemorrhoids Embolization: State of the Art and Future Directions

Rebonato, Alberto; Maiettini, Daniele; Patriti, Alberto; Giurazza, Francesco; Tipaldi, Marcello Andrea; Piacentino, Filippo; Fontana, Federico; Basile, Antonio; Venturini, Massimo

doi:10.3390/jcm10163537

Cited by 8 publications

(13 citation statements)

References 30 publications

(66 reference statements)

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“…In our series, the technical success rate was 100%, with a 14.2% rate of minor complications according to the classification of the Society of Interventional Radiology [ 21 ]. There were no major complications, finding consistent with that reported in recent publications in the medical literature [ 11 , 16 , 17 , 18 , 24 , 42 , 43 , 44 ]. However, recently, Eberspacher Ch [ 45 ] reported a case study of rectal sigmoid ischemia secondary to hemorrhoidal microparticle embolization in a 58-year-old patient.…”

Section: Discussionsupporting

confidence: 91%

Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study

Gregorio

Bernal

Ciampi-Dopazo

et al. 2022

JCM

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Purpose: The purpose of this study was to prospectively evaluate the efficacy and safety of a new, bare platinum, detachable microcoil as a metallic embolization agent in the treatment of hemorrhoidal disease. Material and Methods: This prospective single-center study evaluated a new, bare platinum, electrical, detachable microcoil (Prestige plus coil (Balt Montmorency France)) for use in vascular embolization in patients with hemorrhoidal disease. Between January 2020 and January 2021, 24 embolization procedures were performed in 21 patients (12 males, 9 females; mean age 44.3 ± 7.3). The inclusion criteria were: (a) participants with grade I, II and III hemorrhoidal disease on the Goligher classification; (b) patients older than 18 years of age with a score of greater than 4 on the French bleeding score (FBS) scale; (c) patients with scores greater than 2 on the scale of discomfort proposed by Tradi and Farfallah. (d) patients who underwent treatment that included the use of the new novel coil (Prestige plus coil (Balt)) as an embolic material. The exclusion criteria were participants who failed to provide informed consent and participants diagnosed with rectal bleeding due to other causes (cancer, fissures or others). Participants with severe renal insufficiency, non-correctable coagulation abnormalities and adverse reactions to the contrast medium not correctable with medication were also excluded. The symptoms, technical aspects, the transarterial approach, clinical and technical success complications and short-term outcomes were assessed. Results: Technical success was obtained in 100% of the cases. Seventeen (80.9%) patients experienced improvements in their hemorrhoidal disease. The VAS and QL scores improved by 4 and 1.5 points (81.2% and 87.5%), respectively, after embolization (pV: 0001). Three (14.2%) patients underwent a second embolization due to rebleeding. One patient (4.7%) underwent surgery. No major complications were observed. Three patients had minor complications. The assessment of subjective post-treatment symptoms and QL surveys showed significant differences from the baseline survey. Likewise, the measurement of the degree of satisfaction using a telephone survey at 12 months revealed a high degree of patient satisfaction over 10 points (mean 8.3 ± 1.1). Conclusions: The present study demonstrates that the use of the new, platinum, detachable, electrical microcoil is safe and well-tolerated in the treatment of hemorrhoidal disease. Key points: Catheter-directed hemorrhoidal dearterialization (CDHD) is the procedure of embolization with embolic agents for the treatment of internal hemorrhoids. CDHD is a simple and safe procedure that is accepted by patients and preserves the anal sphincter; it presents few complications when metal devices or microspheres are used as embolic agents. As the recommended embolization agent in treatments, the Prestige electrical, detachable coil is a safe, easy-to-use and effective arterial embolic device.

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Section: Discussionsupporting

confidence: 91%

Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study

Gregorio

Bernal

Ciampi-Dopazo

et al. 2022

JCM

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“…multifactorial [9]. To understand hemorrhoid disease and best determine the approach to its treatment, we must consider the physiology of the rectum and hemorrhoidal vascularization [1]. Corpus cavernosum recti (CCR) constitutes the functional unit of hemorrhoids [10].…”

Section: Anatomical Importance Of Rectal Arteriesmentioning

confidence: 99%

“…Hemorrhoidal disease (HD) is the most common anorectal disease, with a reported prevalence of 4.4-39.0% depending on various variables [1,2]. The age group with the highest incidence is between the ages of 45-65 [3].…”

Section: Introductionmentioning

confidence: 99%

Arterial Embolization as a Prominent Option in the Treatment of Hemorrhoid Diseases

2024

Int J Prev Med Care

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Hemorrhoidal disease (HD) is the most common anorectal disease, affecting millions of people worldwide. The most common clinical picture is rectal bleeding, which significantly impairs the quality of life of patients. Treatment of HD varies from diet and lifestyle changes to radical surgery, depending on the degree and severity of symptoms. Endovascular embolization of superior rectal artery (SRA), known as emborrhoid technique, has recently emerged as a promising minimally invasive approach. Because hemorrhoidal plexuses are almost entirely fed through the SRA. They are also fed less by middle rectal artery (MRA) and rarely inferior rectal artery (IRA). Due to some anastomoses and unpredictable variations, vascular structures must be examined before the procedure. So far, there have been reports of studies involving a small number of patients regarding the use of coils and particles as embolization agents. Some of these used particles and coils alone, while others used a combination of particles and/or coils. The studies demonstrated similar clinical efficacy with satisfactory results, and no significant complications such as ischemic necrosis were observed. The use of liquid embolic agents such as N-butyl-cyanoacrylate (NBCA) and ethylene vinyl alcohol copolymer (EVOH) has also recently been suggested to be effective. In conclusion, the current data support the feasibility, effectiveness, and safety of rectal artery embolization for hemorrhoidal disease. However, there is no guideline or consensus in the selection of embolic materials. More randomized controlled studies are needed. This review aims to evaluate the effectiveness and feasibility of embolization applications in hemorrhoidal diseases.

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“…Early proponents of the angiogenesis theory believed that hemorrhoid tissues originated from cavernous tissues, but it was later found that hemorrhoid vessels were not true cavernous bodies ( Rebonato et al, 2021 ; Yang et al, 2022 ; Palumbo et al, 2023 ). Subsequent studies discovered new vessels in hemorrhoid tissues.…”

Section: Inhibiting Angiogenesis To Delay the Development Of Hemorrhoidsmentioning

confidence: 99%

Traditional Chinese Medicine in the treatment of hemorrhoids—a review of preparations used and their mechanism of action

Zhou,

Jin,

et al. 2023

Front. Pharmacol.

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Hemorrhoids are a proctological disease primarily characterized by bleeding, prolapse, edema, and pain, severely affecting the quality of life. Surgery is an effective treatment for hemorrhoids, but the cost is relatively high, and complications such as difficulty in defecation, persistent pain, and heavy bleeding may occur postoperatively. Traditional Chinese Medicine (TCM) has a distinctive advantage in alleviating the clinical symptoms of hemorrhoid patients, reducing pain, and improving the quality of life. However, there are few summary literature about the mechanism of TCM in the prevention and treatment of hemorrhoids. Based on the etiology of hemorrhoids in both traditional Chinese and Western medicine, this paper reviews the recent research on the mechanism of TCM in the treatment of hemorrhoids, hoping to provide a basis for the better application of TCM in clinical and experimental research.

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Hemorrhoids Embolization: State of the Art and Future Directions

Cited by 8 publications

References 30 publications

Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study

Safety and Effectiveness of a New Electrical Detachable Microcoil for Embolization of Hemorrhoidal Disease, November 2020–December 2021: Results of a Prospective Study

Arterial Embolization as a Prominent Option in the Treatment of Hemorrhoid Diseases

Traditional Chinese Medicine in the treatment of hemorrhoids—a review of preparations used and their mechanism of action

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