Superior rectal artery embolisation for haemorrhoids

2.1 Haemorrhoids occur when the vascular anal cushions become enlarged. Some patients may be asymptomatic but others have symptoms of bleeding, itching or discomfort. Goligher's classification is commonly used to grade haemorrhoids from I to IV. Small symptomatic haemorrhoids are classified as grade I and they do not prolapse. Larger haemorrhoids may prolapse out of the anus. Prolapsed haemorrhoids may reduce spontaneously after defaecation (grade II), may need to be reduced digitally (grade III), or they may not be reducible and remain prolapsed (grade IV).

2.2 Grade I and II haemorrhoids may be managed by changes in diet or using laxatives, or treated by topical applications (such as corticosteroid creams or local anaesthetics). Established interventional treatments include rubber band ligation, sclerosant injections, infrared coagulation or electrocoagulation.

2.3 Established treatments for symptomatic grade III and IV haemorrhoids include haemorrhoidectomy, stapled haemorrhoidopexy, haemorrhoidal artery ligation and electrocoagulation.

2.4 Superior rectal artery embolisation for haemorrhoids is done under local anaesthesia. A catheter is passed into the inferior mesenteric artery through an introducer sheath in a large artery (usually the femoral artery). A microcatheter is then passed into the superior rectal arteries using X‑ray fluoroscopy to confirm correct placement and to identify the branches of the superior rectal artery. Small coils (about 2 mm to 3 mm in diameter) or particles are placed into the most distal branches of the superior rectal arteries, to occlude the blood supply to the haemorrhoids.

2.5 The aim is to occlude permanently the branches that feed the haemorrhoidal plexuses and relieve the symptoms associated with haemorrhoids, such as pain and bleeding.