Which patients with bleeding hemorrhoids benefit from artery embolization, and who should go to surgery instead? On this episode of the BackTable Podcast, Dr. Ally Baheti welcomes Dr. Kristen Rumer and Dr. Scott Thompson of Mayo Clinic to break down patient selection, technique, and follow-up for hemorrhoid artery embolization (HAE) at a major academic center. They explain why bleeding-predominant, Goligher grade II and III internal hemorrhoids are the best candidates, and how the technique has evolved from its origins in France to routine practice in the US.
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This podcast is supported by
Terumohttps://www.terumois.com/haepodcast
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Timestamps
00:00 - Introduction03:33 - Surgical Options and Recovery07:31 - Ideal Candidates for Embolization10:47 - HEMORR1 Trial Design and Embolics15:37 - Arterial Anatomy and Coil Technique19:53 - Collaboration with Colorectal Surgery24:18 - Pelvic Pain and Patient Selection28:48 - Scalability and Contraindications32:02 - Recurrence and Collateral Supply35:27 - Patient Goals and Expectations37:37 - Closing Remarks
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More about this episode
The conversation covers advanced imaging, embolic selection, coil technique, and complication management. Dr. Thompson details the HEMORR1 trial protocol, including photon counting CTA, large spherical particles, and careful coil packing. Dr. Rumer discusses a bidirectional referral pathway and the unmet need for embolization options in anticoagulated and immunosuppressed patients. The episode closes with pearls for avoiding recurrence, managing chronic pelvic pain, and setting realistic expectations so patients understand what success means after HAE.
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Resources
Mayo Clinic: Hemorrhoidal Embolization Trial (HEMORR1)https://www.mayo.edu/research/clinical-trials/cls-20556753 Emborrhoid: Rectal Artery Embolization for Hemorrhoid Disease (Vidal technique)https://pubmed.ncbi.nlm.nih.gov/35781988/ Rectal Artery Embolization for Hemorrhoidal Disease: Anatomy, Evaluation, and Treatment Techniques (RadioGraphics)https://pubs.rsna.org/doi/full/10.1148/rg.220014 Is the Goligher Classification a Valid Tool in Clinical Practice and Research for Hemorrhoidal Disease?https://link.springer.com/article/10.1007/s10151-022-02591-3 Scott M. Thompson, M.D., Ph.D., Mayo Clinichttps://www.mayoclinic.org/biographies/thompson-scott-m-m-d-ph-d/bio-20535376 Kristy K. Rumer, M.D., Ph.D., Mayo Clinichttps://www.mayoclinic.org/biographies/rumer-kristy-k-m-d-ph-d/bio-20519891
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