Emborrhoid: Embolisation of the Superior Rectal Arteries

Haemorrhoids are physiological vascular structures (arterial and venous) normally present at the anal level. Abnormally, distension of this haemorrhoidal network (vascular plexus) can occur, leading among other things to bleeding. Internal haemorrhoidal thrombosis may also occur, causing painful episodes.

Haemorrhoid embolisation is a non-surgical, minimally invasive technique first developed by Russian teams in 1994 and 1998, then published again by Prof. Vincent VIDAL in Marseille (emborrhoid.com) in 2007. This technique aims to treat bleeding from internal haemorrhoids when medical treatments have been exhausted.

It can also be used for recurrences following surgical treatments.

Embolisation is intended only for patients with internal haemorrhoids, which are not visible except on anoscopy (examination performed by proctologists). It treats bleeding only, so this must be the predominant symptom.

It is often offered to patients with chronic symptoms who have failed medical treatments (analgesics, laxatives, venotonics and local anti-inflammatories), instrumental treatments (sclerotherapy, photocoagulation or rubber band ligation) or surgical treatments (internal and external haemorrhoidectomy, haemorrhoidopexy, Doppler-guided arterial ligation and radiofrequency).

Embolisation therefore represents an alternative to heavier surgical-type treatments and corresponds to an endovascular equivalent of Doppler-guided ligation; the result is a reduction in blood flow in the internal haemorrhoidal plexus and thus cessation of bleeding. This technique has the advantage of not immobilising the patient and not causing post-operative pain.

The procedure is performed on an outpatient basis, under local anaesthesia.

The patient is admitted in the morning and discharged in the early afternoon.

The procedure lasts approximately 1 hour on average.

1. The interventional radiologist establishes right femoral or left radial arterial access and introduces a catheter then a microcatheter.
2. They catheterise the inferior mesenteric artery, then the superior rectal arteries, which are occluded using microcoils (small platinum wires, often fibre-coated).
3. The access site is closed using a mechanical closure device.
4. The patient is then reviewed in the day unit to confirm discharge.

There is no significant post-embolisation syndrome and recovery is therefore very straightforward, notably without pain.

Bleeding subsides in the days following embolisation.

The patient is reviewed at 3 months to assess the outcome of the procedure.

A referral letter from the proctologist.

The procedure is reimbursed by the French social security system (Supra-selective embolisation of a branch of the internal iliac artery – EDSF004).

At Bordeaux University Hospital and Clinique Mutualiste de Pessac, no fee over and above standard reimbursement is charged. This may vary between centres.

For patients not covered by French social security, coverage via the European Health Insurance Card may be considered. For patients outside the European Union, a quote can be provided by the healthcare facility.