Episode # 3 • 17 Jan 2025
Understanding Hemorrhoid Artery Embolization Techniques
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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Timestamps
00:00 - Introduction
03:33 - Surgical Options and Recovery
07:31 - Ideal Candidates for Embolization
10:47 - HEMORR1 Trial Design and Embolics
15:37 - Arterial Anatomy and Coil Technique
19:53 - Collaboration with Colorectal Surgery
24:18 - Pelvic Pain and Patient Selection
28:48 - Scalability and Contraindications
32:02 - Recurrence and Collateral Supply
35:27 - Patient Goals and Expectations
37:37 - Closing Remarks
Resources
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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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