Embolization of the superior rectal artery: another management option for hemorrhoids (original) (raw)
Related papers
Hemorrhoids Embolization: State of the Art and Future Directions
Journal of Clinical Medicine
Hemorrhoidal disease is a frustrating problem that has a relevant impact on patients’ psychological, social, and physical well-being. Recently, endovascular embolization of hemorrhoids has emerged as a promising mini-invasive solution with respect to surgical treatment. The purpose of this article is to review the indications, technical aspects, clinical outcomes, and future prospective of endovascular embolization of symptomatic hemorrhoid patients.
CardioVascular and Interventional Radiology, 2020
Objectives To compare safety and clinical outcomes of embolization of the superior rectal arteries in patients with hemorrhoidal bleeding using particles and coils versus coils only. Methods We retrospectively reviewed data for patients undergoing embolization for chronic hemorrhoidal bleeding from January 2014 to April 2017. Embolization was performed with coils alone or with particles and coils. Clinical scores (Paris bleeding severity score, Goligher classification and quality of life score) were obtained, and embolization was performed with microparticles (300-500 lm) followed by fibered pushable coils. Clinical success was defined as an improvement of [ 2 points in the Paris bleeding severity score, without complications. Outcomes were compared between the two groups in a matched-pairs analysis (1:1 scenario), with patients embolized with particles and coils as the study group and patients embolized with coils alone as the control. Results We treated 45 consecutive patients. After matched-pairs analysis, the final study population was 38 patients (19 study group and 19 controls). Clinical success did not differ significantly between the two populations: 63% for control group and 68% for the study group (p = 0.790). The median change in clinical score was-3 [-6;-1] for the control group and-3 [-4;-1] for the study group (p = 0.187). Grade 1 complications were reported in 15% of patients, with no major complications. Conclusions Embolization was feasible, with a technical success of 100% and no major complications. Clinical success was obtained in 66% in patients with no difference when using combined embolization with particles and coils versus coils only.
einstein (São Paulo), 2024
Objective: To describe angiographic findings of the superior rectal artery, its branches, and anatomical variations in the hemorrhoidal plexus in patients undergoing rectal artery embolization for hemorrhoidal disease treatment. Methods: Angiographic findings of 15 patients were obtained from a single-center, prospective clinical study that compared superior rectal artery embolization with the Ferguson technique for hemorrhoidal disease between July 2018 and March 2020. Results: Angiography of the superior rectal artery showed that in seven patients (46.8%), its branches were divided into four main branches (two left and two right), while in four patients (26.6%), the branches divided into one right and two left branches. The most uncommon variation observed in three cases (20%) was the branches divided into two branches to the right and one to the left; no further subdivision into the main branches was observed in one case (6.6%). Conclusion: Four patterns were observed in the angiographic anatomy of the superior rectal arteries. Knowledge of the angiographic anatomy of this region and its variations is essential to improve the effectiveness of superior rectal artery embolization. Registry of Clinical Trials: NCT03402282
International Orthopaedics, 2014
Purpose This prospective randomized pilot study reports our institutional experience and early results using Sonoma Wrx (Sonoma Orthopedic Products, Santa Rosa, CA) in the treatment of extra-articular and simple intra-articular distal radius fractures. Material and methods A total of 64 patients, were enrolled in the study. They were considered eligible if they had; unstable extra-articular distal radius fractures and simple intraarticular distal radius fractures suitable for closed reduction (AO types; A2.2, A2.3, A3.1 C2.1, C2.2). Patients in group I received intramedullary fixation using the Sonoma Wrx® device and patients in group II received standard volar locking plate fixation. Radiographic criteria of acceptable healing were used for evaluation. Results Two groups were similar in terms of baseline characteristics. Mean time of operation was significantly shorter in Group 1 vs. in group 2 (36.81±7.11 vs. 48.97±5.9 minutes, p= 0.001). Time to healing of the fracture was not different between two groups (5.45±1.09 vs. 5.70±1.04 weeks for Group 1 vs. 2, respectively p=0.36). Overall complications occurred in 9 patients in group 1 and in 15 patients in group 2 (p=0.17). Follow-up was completed in all patients with a median time of 12 months and 13 months in group 1 and 2, respectively. On radiographic evaluation radial inclination, radial height and volar tilt were not significantly different between group 1 and 2, respectively. There were no significant differences between two groups in regard to wrist rotational degrees measured in last follow-up visit. Conclusion Sonoma Wrx Device is reliable and effective in terms of achieving satisfactory outcomes in treatment of distal radius fractures. It may be reasonable to use this device to prevent complications that are related to extensive soft tissue dissection.
The Arab Journal of Interventional Radiology, 2020
Purpose: The purpose of this study was to assess the safety and efficacy of using particles only in the embolization of the hemorrhoidal arteries for the management of hemorrhoids. Subjects and Methods: This is a retrospective study for patients treated between March 2015 and December 2018. We treated 33 patients, 13 men and 20 women with a mean age of 37 years (range: 18–70 years), in which 11 patients had Grade II hemorrhoids and 22 had Grade III hemorrhoids. Technical and clinical successes together with procedural complications were assessed. Results: The technical success rate was 100%. No minor or major complications have been reported. No cases of anorectal ischemia, anal incontinence, hemorrhoidal thrombosis, or complications related to femoral arterial puncture have occurred. Follow-up was at 3 months and 12 months postembolization. Clinical success was observed in 32 patients (96.9%) with improvement by at least 2 points of the French bleeding score at 3 months postemboliz...
A New Volar Plate DiPhos-RM for Fixation of Distal Radius Fracture
Techniques in Hand & Upper Extremity Surgery, 2013
We analyzed the efficiency of a new plate DiPhos-RM in CFR-PEEK [carbon-fiber-reinforced poly (etheretherketone)] for the volar fixation of distal radius fractures. The new plate's composition has the advantage of x-ray absolute transparency, therefore allowing to monitor the healing of the fracture. The desired combination of high strength and low rigidity is obtained through the use of the polymer composites CFR-PEEK. In this preliminary study (from March 2012 to June 2012), 10 cases of intra-articular distal radius fractures were treated with DiPhos-RM produced by Lima Corporate (Italy). The fractures were classified according to the AO classification, 4 fractures were type C1, 3 type C2, and 3 were A2. A preoperative computed tomography scan was carried out in all patients. One patient also underwent a postoperative computed tomography scan. Grip strength, range of motion, and DASH score were evaluated at follow-up. There were no cases of hardware failure. Specifically, no loss of position or alignment of fixed-angle locking screws or breakage of the plate were observed. Radiographic union was present at an average of 6 weeks (range, 5 to 8 wk). The overall preliminary experience with this new plate is favorable. The new plate is easy to apply and provides the surgeon dual options of fixed-angle or variable-angle screws. It was rigid enough to maintain the reduction also in AO type C articular fractures. FIGURE 2. A, X-ray with articular fracture type A2. B, Intraoperative view of the implant DiPhos-RM on the volar facet of the distal radius. C, Postoperative x-ray with reduction of the fracture.
Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD). Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure. Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P < 0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR. Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.
Background: RAR (recto anal repair) is a minimally invasive technique which includes haemorrhoidal artery ligation and rectal mucopexy. Objectives: 1)The purpose of this study is to identify the initial and 14th post operative day follow up results. 2) To know the early benefits, and complications that are associated with FGHAL-RAR. Materials and methods: 40 cases of hemorrhoids (both internal and external) admitted in Department of General Surgery, KGH, Visakhapatnam from March 2020 to March 2021 were included in this study.All of them underwent FGHAL-RAR and their postoperative outcomes have been evaluated. Postoperative follow-up was evaluated clinically and by proctoscopy after 2 weeks, 1 month and 3 months respectively. Results: The initial symptomatology was discomfort in daily life, anal blood loss, anal pain and haemorrhoidal prolapse. Around 80% showed symptomatic relief immediately after the operative procedure. After 2 weeks, significant improvement was observed with regard to blood loss, pain and prolapse. The improvement of symptoms were at par as mentioned in literature. After 3 months all the patients were symptom free. Conclusion: FGHAL-RAR procedure is a very effective technique for treatment of high-grade hemorrhoids. It's a minimally invasive technique with no major complications recorded. FGHAL-RAR offers a variety of advantages, including improved treatment of symptoms, lower pain levels, shorter hospital stays, less time off work and high patient satisfaction levels.
The American Journal of Surgery, 2004
The hemorrhoidal artery ligation has been used for submucosal ligation of hemorrhoidal arteries by means of an ultrasonographic transducer since 1995. The success of this technique depends on the submucosal course of these arteries. Our investigation deals with branches of the superior rectal artery which pierce the rectal wall where they cannot be reached by this method. Methods: The branching patterns were investigated by means of 5 macroscopic preparations of adult pelves, histological section series of 35 fetal and 3 adult pelves impregnated in epoxy-resin, and transperineal color Doppler ultrasound of 7 proctologic patients and 28 volunteers. Results: Additional branches of the superior rectal artery coursing in outer layers of the rectal wall were shown entering the rectal wall just above the levator ani muscle to supply the internal hemorrhoidal plexus (corpus cavernosum recti).