Does hemorrhoidal artery embolization really benefit patients with hemorrhoids?

Table 1 Indications or inclusion criteria of hemorrhoidal artery embolization

Indications	Specific situations
Disabling rectal bleeding[10]
Surgical contraindications[16]	Abnormal coagulation function anticoagulants, various acquired or genetic coagulation disorders (cirrhosis, protein S deficiency, haemophilia, etc.)[8,11,23]
	Previous unsuccessful surgery[8,16]
	Poor cardiopulmonary function[34]
No history of surgery[8,10]
Vascular abnormalities	Rectal arteriovenous malformation[12]
	Both hemorrhoidal disease and portal hypertension with rectal varices[35]
No severe prolapse[8]
Wishes of younger active patients[8], immunosuppressed patients[36]
Pathological condition[15]	Morbid obesity, paraplegia

Table 2 Advantages and disadvantages of different embolic materials

Embolic materials	Advantages	Disadvantages
Microcoils	Easy to identify under fluoroscopy[37]	Dependent on a normal coagulation status[38]
	Mild adverse reactions[29]	A non-distal embolization[8]
		Slow symptom relief[22]
Particles	Occluding the distal branches[22]	Particulate reflux[38]
	Higher clinical success rates[23]	An increased risk of local ischemic complications[23]
Liquid embolic materials	A high hemostasis effect with a low recurrent bleeding rate[38]	Vascular glue penetration can be difficult to control[38]
		Unwanted retrograde flow or reflux[39]
		Possibility of ischemic complications[26]