Endovascular embolization in the treatment of acute hemorrhoidal bleeding: a new perspective on differential management in the emergency hospital setting (literature review)

Background. Acute hemorrhoidal bleeding remains a common cause of emergency hospitalization. Treatment traditionally begins with conservative therapy; if ineffective, it progresses to minimally invasive surgical methods. However, in recent years, increasing evidence has accumulated in favor of superselective embolization of the superior rectal artery.

Objective – to substantiate the role of endovascular embolization as a key element of differential management in acute hemorrhoidal bleeding.

Material and methods. A systematic literature review on superior rectal artery embolization was conducted. The search spanned 12 years (2014–2026), with an emphasis on publications from the last 5 years. Searches were performed in PubMed, Scopus, Web of Science, Embase, Google Scholar, DOAJ, and eLibrary using the following keywords and their combinations: “superior rectal artery embolization”, “hemorrhoidal artery embolization”, “emborrhoid”, “rectal artery embolization”, “hemorrhoidal bleeding”, “acute hemorrhoidal bleeding”, “endovascular embolization hemorrhoids”, “minimally invasive hemorrhoid treatment”, “superior rectal artery anatomy”, “embolization outcomes hemorrhoids”, “rectal artery embolization complications”, “emborrhoid technique”, “hemorrhoidal disease interventional radiology”.

Results. Systematic reviews confirm the absence of severe ischemic complications and fatalities associated with superselective superior rectal artery embolization. One of the key advantages of the method is the preservation of anal canal and sphincter anatomy, which is particularly important for patients with pre-existing continence disorders or a high risk of developing them. The absence of the need for anesthesia in the anal canal area and the possibility of performing the procedure under local anesthesia via femoral or radial access make embolization attractive for elderly and frail patients.

Conclusion. Embolization is the method of choice for recurrent bleeding, contraindications to transrectal interventions, patients on anticoagulants, and those with high anesthetic risk. The inclusion of endovascular technologies in clinical guidelines and standards will optimize the management of the most complex category of patients with acute hemorrhoidal bleeding.

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