P3466 - A Novel Clinically Relevant Angiographic Classification System for Hemorrhoid Artery Embolization

Alex Pavidapha, MD¹, Abin Sajan, MD², Jade Lerner, MD¹, Ari Isaacson, MD¹, Atul Marathe, MD³, Rachel Piechowiak, DO¹, Sandeep Bagla, MD^1
1Hemorrhoid Centers USA, Falls Church, VA; ²Columbia University Irving Medical Center, New York, NY; ³Gastro Health, Woodbridge, VA

Introduction: Hemorrhoid artery embolization (HAE) is an emerging and effective intervention to treat patients with symptomatic hemorrhoidal disease. An in-depth understanding of the vascular anatomy is crucial to achieve technical success and avoid non-target related complications. The purpose of this study was to define hemorrhoidal arterial anatomy in a large cohort and propose an angiographic classification system.

Methods: Angiographic findings from 242 HAEs performed between January 2021 and December 2022 were analyzed for the presence, course, and branching patterns of the superior rectal artery (SRA) and middle rectal artery (MRA). Five unique branching patterns were identified based on arterial supply: Type I (bilateral SRA), Type II (unilateral SRA and unilateral MRA), Type III (bilateral SRA and unilateral MRA), Type IV (bilateral SRA and bilateral MRA), and Type V (bilateral MRA).

Results: A total of 242 patients were included in the analysis (average age: 56.5). The distribution of the arterial subtypes were as follows: Type I (110/242, 45%), Type II (7/242, 3%), Type III (86/242, 35%), Type IV (29/242, 12%), and Type V (4/242, 4%). A MRA supply was present in 17 out of 242 patients (7%). Of the 6 patients who initially failed HAE, all 6 patients were noted to have MRA supply requiring reintervention.

Discussion: The arterial supply in hemorrhoidal disease can be complex with numerous common variants. A thorough understanding of the vascular anatomy helps to identify the target vessels and potentially minimize non-target embolization.


Disclosures:


Alex Pavidapha, MD¹, Abin Sajan, MD², Jade Lerner, MD¹, Ari Isaacson, MD¹, Atul Marathe, MD³, Rachel Piechowiak, DO¹, Sandeep Bagla, MD¹. P3466 - A Novel Clinically Relevant Angiographic Classification System for Hemorrhoid Artery Embolization, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.