Hemorrhoid Embolization

Hemorrhoid Embolization

Hemorrhoids, swollen blood vessels in the rectal or anal area, affect millions of people worldwide. While mild cases can often be managed with lifestyle changes and conservative treatments, severe or persistent hemorrhoids may require more advanced interventions, such as hemorrhoid embolization.

Hemorrhoid Embolization: The Procedure

Hemorrhoid embolization, also known as transarterial embolization (TAE), is a minimally invasive procedure designed to treat hemorrhoids by reducing blood flow to the affected area. Here are the key steps involved in hemorrhoid embolization:

1. Pre-procedure Assessment: Before the procedure, patients undergo a comprehensive assessment, which may include a physical examination, medical history review, and imaging studies, such as an MRI or CT scan, to determine the extent and severity of the hemorrhoids.

2. Local Anesthesia: The patient receives local anesthesia to numb the area, ensuring comfort during the procedure. Twilight sedation may also be given through an IV although this procedure is not painful.

3. Catheter Insertion: A small IV sized catheter is inserted into the femoral artery, typically through a tiny nick in the groin area.

4. Guided Imaging: Using fluoroscopy or other real-time imaging techniques, Dr Allaei guides the catheter through the arterial system to the blood vessels supplying the hemorrhoidal tissue.

5. Embolization: Once the catheter is in position, small embolic agents, such as antibiotic beads and/or coils, are introduced into the blood vessels supplying the hemorrhoids. These embolic agents block the blood flow to the hemorrhoidal tissue, causing them to shrink and alleviate symptoms.

6. Post-procedure Observation: After the embolization is completed, the patient is monitored for a short time to ensure there are no immediate complications. Most patients can return home on the same day.

Hemorrhoid Embolization: The Benefits

Hemorrhoid embolization offers several benefits for individuals suffering from severe or recurring hemorrhoids:

1. Non-surgical: Hemorrhoid embolization is minimally invasive, involving only a small skin nick and typically performed on an outpatient basis. This means less pain, a shorter recovery period, and reduced scarring compared to traditional surgical options.

2. Effective Symptom Relief: Clinical studies have shown that hemorrhoid embolization can provide effective relief from symptoms such as pain, bleeding, and discomfort associated with hemorrhoids.¹

3. Low Risk: Hemorrhoid embolization is associated with a lower risk of complications, such as infection or wound healing problems, when compared to surgical procedures like hemorrhoidectomy.²

4. Preservation of Rectal Function: Unlike some surgical treatments that may alter rectal function, embolization typically preserves normal rectal function.

Hemorrhoid Embolization: The Risks

While hemorrhoid embolization is generally considered safe, there are some potential risks and complications to be aware of:

1. Pain or Discomfort: Patients may experience mild pain or discomfort at the catheter insertion site or in the rectal area. This can usually be managed with over-the-counter pain medications.

2. Infection: Although rare, there is a small risk of infection at the catheter insertion site. Patients should follow post-procedure care instructions carefully to minimize this risk.

3. Bleeding: In some cases, patients may experience minor rectal bleeding after the procedure. This typically resolves on its own but should be reported to the healthcare provider.

4. Recurrence: While hemorrhoid embolization is effective for many patients, there is a possibility of hemorrhoid recurrence in the future. Lifestyle modifications and dietary changes may be necessary to prevent recurrence.

5. Allergic Reaction: Some individuals may have allergic reactions to the embolic agents used during the procedure. However, this is extremely rare.

6. Arterial Perforation: There is a very low risk of arterial perforation, which can lead to bleeding. This is a rare complication but should be addressed promptly during the case if it occurs.

In the hands of a trained Vascular and Interventional Radiologist these risks are minimal.

Hemorrhoid Embolization: Expectation

Recovery following hemorrhoid embolization is typically faster and less painful compared to traditional surgical treatments. Here is what patients can expect after the procedure:

1. Immediate Relief: Many patients experience immediate relief from hemorrhoid symptoms, such as pain and bleeding, after the procedure.

2. Post-Procedure Care: Patients will receive instructions on how to care for the catheter insertion site and manage any discomfort. It’s essential to follow these instructions carefully to ensure a smooth recovery.

3. Resuming Activities: Most patients can return to normal activities, including work, within a few days to a week after the procedure. Strenuous activities and heavy lifting should be avoided for a short period. Otherwise, there is no downtime.

4. Dietary Changes: Patients may be advised to make dietary changes, such as increasing fiber intake and staying well-hydrated, to prevent future hemorrhoid flare-ups.

5. Follow-Up: A follow-up appointment with the healthcare provider may be scheduled to monitor the progress and ensure the hemorrhoids are responding to the treatment.

Hemorrhoid embolization is a minimally invasive procedure that offers several benefits, including effective symptom relief, minimal risk of complications, and preservation of rectal function. While there are potential risks and discomfort associated with the procedure, they are generally outweighed by the benefits for individuals with severe or recurrent hemorrhoids, and certainly marginal compared to surgery. Patients should consult with their healthcare provider to determine if hemorrhoid embolization is the right treatment option for their specific condition.

References:

1. Simillis C, Slesser A, Lacy-Colson J, et al. Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. *The British Journal of Surgery*. 2015;102(13):1603-1618. doi:10.1002/bjs.9923

2. Liu J, Guan Q, Li L, Li Y. Efficacy of Transcatheter Arterial Embolization for Severe Hemorrhoidal Bleeding. *Diseases of the Colon & Rectum*. 2020;63(6):769-775. doi:10.1097/DCR.0000000000001617

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.