Abstract
BACKGROUND: This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated. METHODS: Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was assessed using the Paris bleeding severity score. Femoral artery access was utilized for embolization in all patients, and superior rectal artery branches were embolized exclusively with coils. All patients were treated electively except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was conducted via clinical examination and rectoscopy at 1, 3, and 6 months. RESULTS: All patients underwent successful treatment with 100% technical success. No procedure-related ischemic complications or femoral artery puncture-related complications were observed in any patient. All patients were classified as grade 4 according to the Goligher classification prior to treatment. The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 at the first month, 3.8±1.61 at the third month, and 3.6±1.29 at the sixth month. Recurrence occurred in one patient at the first month and in another at the third month. Clinical success was 95% at the first month and 85% at the third and sixth months. Re-embolization was not performed in patients with recurrence. CONCLUSION: In conclusion, this study demonstrates that coil embolization of the superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade 4 hemorrhoidal disease and the elective treatment of patients unsuitable for surgical intervention.