Hemorrhoid Artery Embolization

Hemorrhoidal Artery Embolization (HAE): Detailed Explanation

Hemorrhoidal Artery Embolization (HAE) is a minimally invasive, image-guided procedure used to treat symptomatic internal hemorrhoids—particularly chronic or severe hemorrhoidal disease that doesn’t respond to conservative treatments. This innovative approach offers an alternative to surgery, providing symptom relief with fewer risks, less pain, and quicker recovery.

What Are Hemorrhoids?

Hemorrhoids are swollen and inflamed veins in the lower rectum and anus. They are categorized into two types:

  • Internal Hemorrhoids: Located inside the rectum, often painless but may cause bleeding.
  • External Hemorrhoids: Located under the skin around the anus, often painful and itchy.

Hemorrhoidal disease is common, affecting up to 50% of adults at some point in their lives, especially those aged 45-65 years.

What Is Hemorrhoidal Artery Embolization (HAE)?

Hemorrhoidal Artery Embolization is a minimally invasive, endovascular procedure that reduces blood flow to the internal hemorrhoidal arteries. This cuts off the excess blood supply to the hemorrhoids, causing them to shrink and alleviate symptoms like bleeding, pain, and prolapse.

HAE is typically performed by an interventional radiologist using advanced imaging techniques.

How Does the Procedure Work?

  1. Pre-Procedure Evaluation:
    • Medical history review and physical examination.
    • Colonoscopy or proctoscopy to assess the severity of hemorrhoids.
    • Imaging tests like CT angiography or Doppler ultrasound to map the hemorrhoidal arteries.
  2. Preparation:
    • Local anesthesia at the catheter insertion site.
    • Mild sedation may be administered (no general anesthesia needed).
  3. Arterial Access:
    • A small puncture is made in the femoral artery (groin) or radial artery (wrist).
    • A thin catheter is inserted into the artery.
  4. Catheter Navigation:
    • Using fluoroscopy (real-time X-ray imaging) and contrast dye, the catheter is guided into the superior rectal arteries—the main arteries supplying blood to the hemorrhoids.
  5. Embolization:
    • Tiny microspheres or embolic particles are injected into the hemorrhoidal arteries to block blood flow.
    • This reduces blood supply to the hemorrhoids, causing them to shrink over time.
  6. Completion:
    • The catheter is removed, and the incision site is closed with a small bandage.
    • The procedure typically takes 60-90 minutes.

Who Is a Candidate for HAE?

HAE is recommended for patients with:

  • Chronic hemorrhoidal bleeding that doesn’t respond to conservative treatments (dietary changes, medications, or topical ointments)
  • Hemorrhoids graded I to IV (with persistent symptoms or prolapse)
  • Patients seeking a non-surgical alternative to hemorrhoidectomy
  • Those who cannot undergo surgery due to medical conditions

Benefits of Hemorrhoidal Artery Embolization

  • Minimally invasive
  • Performed under local anesthesia
  • Outpatient procedure (same-day discharge)
  • Lower risk of infection
  • Faster recovery (1-3 days)
  • Significant symptom relief
  • Lower recurrence rates compared to some surgical methods

Risks and Complications

While generally safe, HAE may have some risks, including:

  • Minor bruising at the catheter site
  • Temporary pelvic pain or discomfort
  • Rectal bleeding (usually temporary)
  • Infection (rare)
  • Non-target embolization (rare)

Recovery

  • Most patients can return to normal activities within 24-48 hours.
  • Mild pelvic discomfort may last a few days.
  • Symptom improvement begins within 1-2 weeks.
  • Maximum improvement is typically seen within 4-6 weeks.

Success Rate

Studies show that 70-90% of patients experience significant symptom relief after HAE, with lasting results and minimal complications.

How Does HAE Compare to Other Treatments?

Treatment Invasiveness Anesthesia Recovery Time Pain Level Recurrence Rate Outpatient
Rubber Band Ligation Minimally invasive None 1-2 days Moderate 10-20% Yes
Hemorrhoidectomy Surgical General 2-4 weeks High 5-10% No
Stapled Hemorrhoidopexy Minimally invasive General 1-2 weeks Moderate 10-15% No
Hemorrhoidal Artery Embolization Minimally invasive Local 1-3 days Low 5-10% Yes

Advantages of HAE Over Surgery

  • No need for general anesthesia
  • Lower risk of pain and bleeding
  • Faster recovery
  • Less invasive
  • Suitable for patients with multiple medical conditions

Limitations of HAE

  • Not be suitable for external hemorrhoids
  • Rare chance of recurrence in severe cases

Conclusion

Hemorrhoidal Artery Embolization (HAE) is a highly effective, minimally invasive treatment for chronic hemorrhoidal disease. It offers a faster recovery, fewer complications, and significant symptom relief compared to traditional surgical methods.

If you’re considering HAE, consult with an interventional radiologist to determine if you’re a suitable candidate.

Would you like an infographic of the procedure or help finding specialists offering HAE near you?