The Use of Fluorescence Angiography for Confirmation of Hemorrhoid Dearterialization

摘要

Symptomatic hemorrhoids have a documented prevalence of up to 40 per cent in the United States. While most symptomatic hemorrhoids can be treated with conservative measures such as diet modification and topical agents, as many as 10 million people in the United States will have the disease. Presently, hem-orrhoidectomy is the gold standard for symptomatic hemorrhoids refractory to medical management. Hemorrhoid artery ligation (or dearterialization) with Doppler guidance and mucopexy is becoming a popular alternative. We report an alternative method of confirming hemorrhoid dearterialization using fluorescence angiography by presenting a 48-year-old African-American man with chronic symptomatic grade III internal hemorrhoids. He elected to have hemorrhoid dearterialization with mucopexy. A six-point hemorrhoid transanal hemorrhoid dearterialization and mucopexy was completed using Doppler guidance. However, due to the significant amount of prolapsed tissue, fluorescence angiography was used to assess hemorrhoid cushion perfusion and confirmed dearterialization at the points of hemorrhoid artery ligation. All cushions ligated were found to have lost or weakened signal on angiography. He had no symptoms of recurrence during follow-up. Fluorescence angiography should be considered as a safe and effective tool for confirmation of hemorrhoidal dearterialization.