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Session:: ePosters-Mon800-M7: Benign Anorectal

EP777 - Rectal Artery Embolization for Bleeding Internal Hemorrhoids is Safe and Effective for High Operative Risk Patients

Monday, May 11, 2026
8:43 AM - 8:48 AM ET

    ePoster Presenter(s)

  • Samuel H. Lai, MD

    Resident
    University of Colorado School of Medicine, Department of Surgery
    University of Colorado School of Medicine
    Aurora, CO, United States

    Disclosure information not submitted.

    • Author(s)

  • Dimitrios N. Varvoglis, MD (he/him/his)

    General Surgery Resident
    University of Colorado Anschutz Medical Campus
    University of Colorado
    Aurora, CO, United States

    Disclosure information not submitted.

  • IZ

    Ioannis A. Ziogas, MD, MPH

    Resident Phycisian
    University of Colorado School of Medicine
    Denver, Colorado, United States

    Disclosure information not submitted.

  • JL

    Jon Lindquist, MD

    Associate Professor
    University of Colorado Anschutz
    Aurora, Colorado, United States

    Disclosure information not submitted.

  • JH

    James Hart, MD

    Associate Professor of Radiology
    University of Colorado School of Medicine, Department of Interventional Radiology
    Aurora, Colorado, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • MM

    Michael S. McNevin, MD

    Associate Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    Disclosure information not submitted.

Purpose/Background: Despite overall effectiveness, hemorrhoidectomy can lead to significant postoperative pain, bleeding, fecal incontinence, anorectal stenosis, and life-threatening infection. Rectal artery embolization (RAE) may be an alternative for patients with bleeding hemorrhoids, who may otherwise be poor operative candidates or not suitable for office-based procedures. This study aimed to assess the effectiveness of RAE for bleeding in patients with symptomatic hemorrhoidal disease.

Methods/Interventions: Retrospective cohort study of patients who underwent RAE at an academic quaternary medical center between April 2023 and April 2025. Primary clinical success was defined as resolution of acute bleeding or reduction of French Bleeding Score (FBS) by 2 points without any additional interventions. Bleeding recurrence-free survival (BRFS) calculated with Kaplan-Meier analysis.

Results/Outcomes: 31 patients (median age 48.2, IQR 39.0-64.5) underwent RAE for significant hemorrhoidal bleeding (median FBS: 8 [IQR 6.0-8.0]). Significant comorbidities including coronary artery disease, heart failure, decompensated cirrhosis, pulmonary embolism, pulmonary hypertension, lymphoma, and metastatic colon cancer were present in 26/31 (83%). 12/31 (39%) were on anticoagulation and/or antiplatelets. Median number of vessels embolized was 4 (IQR 4-5) with technical success achieved in 100%.

Primary clinical success was achieved in 18/31 (58%), while 13/31 (41%) underwent repeat RAE for continued or recurrent bleeding with secondary clinical success rate of 5/13 (33%). 9/31 (29%) underwent hemorrhoidectomy after failed RAE with median of 9.7 (3.6 - 11.7) months to surgery. 5 complications occurred in 4/31 (13%) patients, including guide wire fracture, inferior mesenteric artery dissection requiring angioplasty, access site hematoma, and significant anal pain. 30-day mortality unrelated to procedure was 6.5%.

3-, 6-, and 12-month bleeding recurrence free survival was 78.6% (95% CI 58.4-89.8%), 57.4% (95% CI: 36.0-74.0%), and 39.3% (95% CI 20.1-58.1%), respectively. There were significant improvement in FBS from pre- to post-procedure at 8 (6-9) to 4 (2-5), respectively (p < 0.01). Similarly quality of life score with HDSS was significantly better overall comparing pre- to post-procedure at 8 (6-10) to 4 (1-7), respectively (p=0.027).

Conclusion/Discussion: Rectal artery embolization for bleeding internal hemorrhoids may be a safe alternative or a bridging treatment for patients who are poor operative candidates or not suitable for office based procedures with acceptable medium-term results.

Bleeding Recurrence Free Survival
Symptoms and Quality of Life Scores Before and After Embolization