Superior Rectal Artery Embolization for Symptomatic Grades 2 and 3 Hemorrhoidal Disease: 6-Month Follow-up among 43 Patients

Stecca, Tommaso; Farneti, Fabrizio; Balestriero, Giovanni; Barban, Mario; Caratozzolo, Ezio; Zilio, Silvia; Massani, Marco

doi:10.1016/j.jvir.2021.06.005

Cited by 8 publications

(7 citation statements)

References 20 publications

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“…Our findings demonstrate that the benefit of Emborrhoid was not associated with the hemorrhoidal, probably due to the small size of the study cohort. However, in a previous study, we reported that Emborrhoid was more effective in grade 2 than in grade 3 hemorrhoids, with 84% vs 50% of symptoms resolution, respectively at the 6 mo follow-up[ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

Tutino,

Stecca,

Farneti

et al. 2024

World J Gastroenterol

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BACKGROUND Hemorrhoidal artery embolization (Emborrhoid) is a novel method for the treatment of severe hemorrhoidal bleeding. Despite having a technical success rate of 93%-100%, the clinical success ranges between 63% and 94%, with a rebleeding rate of 13.6%. AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding. METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center, Treviso Regional Hospital, Italy. In a 2 months period (February-March 2022), consecutive patients with hemorrhoidal bleeding scores (HBSs) ≥ 4, Goligher scores of II or III, failure of non-operative management, and a candidate for Emborrhoid were included. Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure. The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment. The secondary endpoint was to evaluate the correlation between the flow changes and the HBS. RESULTS Eleven patients underwent Emborrhoid. The overall pretreatment mean systolic peak (MSP) was 14.66 cm/s. The highest MSP values were found in the anterior left lateral (17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock) and in the posterior right lateral (14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock) quadrants of the anal canal. After treatment, the overall MSP values were significantly reduced (P = 0.008) although the correlation between MSP and HBS changes was weak (P = 0.570). A statistical difference was found between distal embolization compared with proximal embolization (P = 0.047). However, the coil landing zone was not related to symptoms improvement (P = 1.000). A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery (SRA) anatomy (P = 0.040). No relationship between hemorrhoidal grades (P = 1.000), SRA anatomy (P = 1.000) and treatment outcomes was found. CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease. However, the correlation between the post-operative MSP and HBS changes was weak. Hemorrhoidal grade, SRA anatomy and type of embolization were not related to treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria were a Goligher score of IV, pregnancy, previous hemorrhoidal surgery, inflammatory bowel disease. Use of anticoagulants or anti-aggregants was not considered an exclusion criterion[ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

Tutino,

Stecca,

Farneti

et al. 2024

World J Gastroenterol

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“…In most of the published series, technical success rates of 90–100% have been reported, while clinical success rates range from 63% to 97% [ 11 , 12 , 16 , 17 , 18 , 19 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. However, it is difficult to compare the results from the different series as there is no single and homogeneous criterion and standard that defines clinical success [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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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“…Once fasting and adequate hemostasis are confirmed, the procedure is performed under aseptic conditions in a room equipped with a digital angiography. Conscious sedation is used, and local anesthetic is injected at the puncture site, which most commonly is the right femoral artery [25][26][27][28][29][30].…”

Section: General Techniquementioning

confidence: 99%

“…Coils are the most often documented embolic material; regardless, the usage of particles and coils is preferred by some working groups. Previous injection of 300-500 µm polyvinyl alcohol (PVA) particles within the distal part of SRA branches, near the CCR; followed by coil embolization of the SRA branches themselves, may close hemorrhoid plexus more distally and obstruct persistent MRA anastomoses, as shown in Figure 2 (Table 4) [25][26][27][28][29][30][31][32]. A recent study showed that larger microspheres (900-1200 µm) have better long-term efficacy and no minor ischemic complications compared with smaller sizes [33].…”

Section: General Techniquementioning

confidence: 99%

Prevalent Technique and Results of Hemorrhoidal Embolization

Gil

Puchol

Solaz

et al. 2022

JCM

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Hemorrhoids are blood cushions located in the anus and lower rectum, acknowledged as a common cause of bleeding, which can reduce quality of life. The development of minimally invasive techniques such as endovascular embolization of superior rectal artery, “Emborrhoid technique”, is an effective treatment, with no pain or ischemic complications, and allows quick patient recovery. Our purpose is to describe the general technique and discuss the results of the current literature.

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Superior Rectal Artery Embolization for Symptomatic Grades 2 and 3 Hemorrhoidal Disease: 6-Month Follow-up among 43 Patients

Cited by 8 publications

References 20 publications

Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

Transanal eco-Doppler evaluation after hemorrhoidal artery embolization

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

Prevalent Technique and Results of Hemorrhoidal Embolization

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