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Hemorrhoid Artery Embolizaztion

(HAE) (Emborrhoid)

I have rectal bleeding and have heard there is a new treatment called Hemorrhoid Artery Embolization (HAE). Do you recommend HAE? 

At HCA we do not recommend HAE. Rubber band ligation (RBL) is a faster, easier, more proven, less expensive way to treat internal hemorrhoids. At HCA we can treat all grades of internal and external hemorrhoids. HAE can only treat internal hemorrhoids. We have the training and expertise to carefully examine the area to make sure you are getting the best treatment available. HAE is usually done by a radiologist who may not have the years of training and experience that you will find at HCA in examining and treating the rectal area.

HAE is a new option for bleeding internal hemorrhoids. “However, embolization is not effective in all patients, and some undesirable complications and failures are not uncommon.” (1)

HAE is recommended by some to avoid the pain of surgery or rubber band ligation (RBL). We have 20 plus years of experience with RBL. Over 95% of our patience experience no significant pain. The O’Regan ligation system is a marked improvement over the metal grasper system used by many other doctors. The combination of our technology, experience, and training allow us to provide you the best in care for hemorrhoids and other rectal health issues. As many as 50% of patients with rectal bleeding will have other conditions such as anal fissures that require treatment. At HCA we have many years of training and experience examining, diagnosing, and treating a variety of rectal conditions.

At HCA we recommend Rubber band ligation of bleeding Internal Hemorrhoids. It has been the preferred nonsurgical option for the last 20 years or more. It has been done over 50,000 times at Hemorrhoid Centers of America with excellent results and minimal discomfort. The success rate is over 95% with a complication rate of .2% per band. The use of topical ointments and the O’Regan ligator leads to minimal discomfort and little to no restrictions post banding. You can return to work the same day in most cases.

HAE is performed by an interventional radiologist. Blood vessel x-ray (angiography) is performed under local anesthesia. A catheter is placed into an artery in the leg or arm. The artery feeding the hemorrhoids are blocked embolized) with coils or other materials-particles to decrease blood flow. This is a relatively new treatment option (2015) that may improve bleeding without the pain of surgery. Long term results require further studies.

Risks include pain, swelling, fever, ischemic damage, rectal stenosis, ulcerations of rectum due to ischemia or decreased blood flow, rectal bleeding, abdominal pain, nausea, vomiting, transient rise in liver enzymes, and radiation exposure. Repeat embolization may be needed because of incomplete treatment. Variations in the artery anatomy may increase failures.

Success rates range from 64-93%. Rectal prolapse does not seem to be consistently helped. No significant hemorrhoid grade change is observed after treatment. Blood clots or phlebitis have  been reported. Decreased blood flow to the rectal area may make any future surgery in the area may be more difficult. Contraindications for endovascular treatment include severe renal impairment, contrast medium allergy, and the lack of vascular access. Other contraindications include acute hemorrhoid complications, chronic anal or perianal fissures, and colorectal cancer. Emborrhoid in patients with inflammatory bowel disease remains controversial. (1)

Recurrence necessitating repeat treatment affected 8-20% of patients, usually when collateral arterial supply persisted. Patient-reported satisfaction exceeded 80% in every series. Only two small, heterogeneous comparative studies versus rubber-band ligation or sclerotherapy were available, precluding a pooled analysis. (2)

However, it is not recommended for patients with grade IV internal hemorrhoids, external hemorrhoids or thrombosed hemorrhoidal disease, or contraindications to interventional procedures. (3)

 

Most Interventional Radiologist have limited training in anal rectal health. They may not be trained in anoscopy/rectal examination. Not all rectal bleeding is from hemorrhoids. Many patients with rectal pain/bleeding may have other conditions such as anal fissures, cancer, proctitis, or infections. Most Radiologist depend on a recent colonoscopy to “exclude other problems.” Colonoscopy is not needed in most hemorrhoid cases, but an experienced specialist can help determine who would benefit from Colonoscopy. Not examining the anal and rectal area before treatment of “hemorrhoids” is going to increase the risk of misdiagnosis and treatment failures. Decreased rectal blood flow could make anal fissure healing more difficult.

Call us today for a consultation with one of our hemorrhoid experts with many years of experience and excellent results with nonsurgical options.

 

LETTER

World J Gastroenterol

  1. . 2024 Nov 14;30(42):4569–4575. doi: 3748/wjg.v30.i42.4569
  2. Int J Colorectal Dis. 2025 Aug 29;40(1):190.doi: 10.1007/s00384-025-04944-4.

 

Front Med (Lausanne)

  1. 2025 Feb 26;12:1530981. doi: 10.3389/fmed.2025.1530981

 

About 1 in 20 Americans have hemorrhoids. You are not alone.

Dr. Alan Goldman
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