Technical Feasibility and Short Term Outcomes of Hemorrhoidal Artery Embolization via Transradial Access

Purpose: To assess safety and feasibility of hemorrhoidal artery embolization (HAE), a novel treatment option for internal hemorrhoids, via transradial (TR) arterial access. TR access overcomes the acute angulation challenge of the inferior mesenteric artery origin, and may allow for a more distal embolization. Objective outcomes for TR hemorrhoidal artery embolization performed for rectal bleeding are difficult to assess; patient reported satisfaction rates are thus analyzed.

Materials and Methods: 11 consecutive patients underwent TR hemorrhoidal artery embolization between November 2018-June 2019, and were retrospectively analyzed 3 months post procedure. Primary outcome measure was patient reported satisfactionat 3 months. Secondary outcome measure was patient reported improvement in rectal bleeding. Indications for treatment included bleeding due to internal hemorrhoids (grade II-III), and contraindication to surgical hemorrhoidectomy.

Results: Follow up data was available in 8 patients. Technical success, including distal superselective catheterization and embolization of the hemorrhoidal arteries, was achieved in 8/8 TR patients (100%). 6/8 (75%) patients were satisfied with the procedure at 3 months. 5/8 (62.5%) patients reported improvement in rectal bleeding. No major adverse events were noted. One patient reported increase in rectal pain and rectal bleeding post procedure. All patients were discharged 2-hours post procedure.

Conclusions: Transradial arterial access for hemorroidal artery embolization appears to be a safe and feasible option, and allows for same day hospital discharge. TR access may allow for a more distal embolization than TF access. Patient satisfaction rates are high and subjective decrease in rectal bleeding rates appear to be acceptable.