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

Imaging for Hemorrhoidal Disease: Navigating Rectal Artery Embolization from Planning to Follow-up

Hemorrhoid disease is very common, affecting greater than one-third of adults. Conservative management and several office-based procedures are useful in the treatment of internal hemorrhoids. Patients with refractory hemorrhoid disease have traditionally been treated with surgical hemorrhoidectomy. Rectal artery embolization has emerged as an alternative to surgical hemorrhoidectomy and has been shown to be safe and effective in case series and clinical trials completed over the past decade. Embolization has significantly less postprocedure pain when compared with surgical hemorrhoidectomy with similar outcomes. Pre- and postprocedure imaging are not routinely performed. Intraprocedural imaging consists of selective catheterization of the superior rectal arteries from the inferior mesenteric artery, and the middle rectal arteries from the internal iliac artery. The inferior rectal artery is seldom embolized due to the supply of the levator ani muscle and skin. To date, intermediate and large particles and fibered and nonfibered coils have been used successfully.

Safety and Efficacy of Prestige Coils for Embolization of Vascular Abnormalities: The Embo-Prestige Study

A wide variety of coils are available for vascular embolization. This study aimed to evaluate the safety and efficacy of a new Prestige coil. We carried out retrospective analysis of a multicenter's registry data collected between February 2022 and November 2022. The choice of embolization agent used to treat peripheral vascular anomalies was left to the investigator's discretion. Patients for whom at least one Prestige coil was used were included in Series 1. All other patients were included in Series 2. Efficacy and safety were evaluated. Patients were followed up for one month. In total, 220 patients were included, 110 in each series. Patients included 149 men (67.7%) and 71 women (32.3%), with a median age of 62.5 years (IQR: 35.8-73). Patient ages were similar in the two series. Complete occlusion of the targeted vessel was reported in 96.4% (n = 106/110) of patients in Series 1 and in 99.7% (n = 109/110) in Series 2. Four patients experienced non-serious adverse events (1.8%, n = 4/220): one experienced back pain and one vomiting in Series 1; one patient had off-target embolization and one a puncture site hematoma in Series 2. Sixteen patients (7.2%, n = 16/220) were lost to follow up. Improvement in the patient's general state at one month was reported in 79.0% (n = 83/105) of patients in Series 1 and in 74.7% (n = 74/99) in Series 2. Ten deaths occurred, five in Series 1 (4.8%, n = 5/105) and five in Series 2 (5.1%, n = 5/99). These deaths all concerned critically ill patients embolized for emergent arterial bleeding. In conclusion, the 1-month follow-up showed that Prestige coils, alone or in combination, are efficient and safe.

Prevalent Technique and Results of Hemorrhoidal Embolization

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.