13th Annual Global Embolization Symposium & Technologies
Purpose : To assess safety and feasibility of hemorrhoidal artery embolization (HAE) via transradial (TR) arterial access. Transfemoral (TF) access for HAE requires use of a reverse curve catheter to overcome the nearly 180-degree angulation of the inferior mesenteric artery course off of the aorta; this may limit the ability to achieve distal superselective catheterization of the hemorrhoidal arteries. TR access overcomes this acute angulation challenge, and may allow for a more distal embolization.
Material and Methods : Four consecutive patients who underwent hemorrhoidal artery embolization between November 2018 and December 2018, were retrospectively analyzed. Indications included a chief complaint of bleeding due to internal hemorrhoids (grade II-III), and a relative contraindication to surgical hemorrhoidectomy. These included inflammatory bowel disease and need for continuous anticoagulation. A single operator performed all procedures at a single institution.
Results : Technical success, including distal superselective catheterization and embolization of the hemorrhoidal arteries, was achieved in 4/4 TR procedures (100%). No major adverse events were noted. One patient (25%) experienced a small (<5 cm) hematoma at the TR access site. All patients were discharged home on same day, 2-hours post procedure.
Conclusions : Transradial arterial access for hemorroidal artery embolization appears to be a safe and feasible option for hemorrhoidal artery embolization, and allows for same day hospital discharge. TR access may allow for a more distal embolization than TF access. Future studies are needed to compare distal embolization endpoints between TR and TF access, their impact on symptom recurrence, as well as comparative procedure and fluoroscopy times.