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Review
. 2022 Jun 30;39(2):194-202.
doi: 10.1055/s-0042-1745800. eCollection 2022 Apr.

Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease

Julien Panneau  1   2   3 , Diane Mege  4 , Mathieu Di Biseglie  1   2   3 , Julie Duclos  4 , Paul Habert  1   2   3 , Vincent Vidal  1   2   3 , Farouk Tradi  1   2   3
Affiliations
Review

Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease

Julien Panneau et al. Semin Intervent Radiol. .
No abstract available

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Illustration of the common anatomical variation of the vascularization of the corpus cavernosum recti (CCR). Most of the time, there are only hypertrophic SRAs ( a ). Occasionally present are hypertrophic MRAs with or without hypertrophic SRA ( b ). CIA, common iliac artery; IMA, inferior mesenteric artery; IPA, internal pudendal artery; IRA, inferior rectal artery; MRAs, middle rectal arteries; SRAs, superior rectal arteries.
Fig. 2
Fig. 2
Pelvic CTA 3D ( a ) and digital subtraction angiography ( b ) showing superior rectal arteries (SRAs) (arrows). SRAs arise from the inferior mesenteric artery and feed mainly the corpus cavernosum (asterisk).
Fig. 3
Fig. 3
Pelvic CTA, maximum intensity projection ( a ) and 3D images ( b ) showing a hypertrophic right middle rectal artery (MRA). MRA arises from the pudendal artery and feeds mainly the corpus cavernosum recti with a blush (yellow arrow).
Fig. 4
Fig. 4
Frontal digital subtraction angiography showing a modal anatomy of the inferior mesenteric artery (asterisk), superior rectal arteries (yellow arrow), sigmoid arteries (red arrow), and left colic arteries (blue arrow).
Fig. 5
Fig. 5
A 49-year-old man with internal hemorrhoids treated by embolization of the upper rectal arteries. Angiography before embolization without ( a ) and with digital subtraction ( b ). Visualized are the common superior rectal artery (SRA) trunk (asterisk), superior left rectal artery (white arrow), and terminal branches of the SRA that supply internal hemorrhoids in the pubic bone (yellow arrow).
Fig. 6
Fig. 6
Selective injection of the digital subtraction angiography in the left superior rectal artery makes it possible to unmask by retrograde opacification in the left middle rectal artery that is hypertrophic (yellow arrow).
Fig. 7
Fig. 7
Catheterization of the ostium of the inferior mesenteric artery using a Simmons 4FR catheter ( a , b ) and then 3D arteriography of the superior rectal artery identifying the target branches and allowing a progression of the microcatheter to the left anterior branch ( c , d ). Occlusion of the left anterior branch and the other branches using micro-coils ( e , f ). At the end of the procedure, no residual branch is opacified under the pubic symphysis.
Fig. 8
Fig. 8
Catheterization of the ostium of the inferior mesenteric artery (arrow) using a Simmons 4FR catheter ( a ), then arteriography of the superior rectal artery identifying the target branches (arrow) ( b ), evidence of a large left middle rectal artery (arrow) ( c ), and catheterization of the left middle rectal artery (asterisk)( d ).
Fig. 9
Fig. 9
Cone-beam CT after opacification of the right internal iliac artery ( a ) revealing the left middle rectal artery supplying part of the CCR projecting from the pubis. Route planning after VR reconstruction of the right middle rectal artery (arrow) ( b ).
Fig. 10
Fig. 10
Diagram of hemorrhoidal disease diagnosis and treatment. HBS, hemorrhoid bleeding score.
See this image and copyright information in PMC

References

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