The variability of MRA origin is well known from the experience obtained with prostate arterial embolization (PAE). The frequency of the middle rectal artery is reported to range from 12 to 97% and presents several variances in its origin and path. About 2–3 cm above the dentate line, twisting arteries of maximum diameter 2 mm emerge towards the mucosal surface. The main trunk of the superior rectal artery bifurcates, in the center, about 12 cm above the dentate line, in four (occasionally three or five) large branches, two posterior (one right and one left) and two lateral branches (one right and one left) each branch partially spiraled around the central axis of the rectum and subsequently separated into 5–7 branches penetrating the bowel wall 3–4 cm above the elevators ani and traverses the muscle wall. The branches of the inferior mesenteric artery include: (1) the left colic, which is located retroperitoneally and supplies the descending colon (2) the sigmoid branches, which supply the sigmoid colon (3) the superior rectal artery, which is the terminal branch of the inferior mesenteric artery at the pelvic rim.

The IMA comes off the anterolateral aspect of the left side of the aorta just above the bifurcation of the common iliac arteries usually at 元. The most prevalent arterial supply of the CCR derives from SRA and, therefore, from the inferior mesenteric artery (IMA). The comprehension of the arterial component of the HD and the positive results of the Doppler-guided hemorrhoidal artery ligation (DG-HAL) led to the development of the “emborrhoid technique”. presented their data demonstrating that arterial hyperplasia both of the submucosal rectal arteries and transmural branches of the SRA correlates significantly with the appearance and the grade of HD. These veins represent the venous hemorrhoidal plexus and drain both in the portal and systemic system so, the CCR has no direct connection to the portal or cava vein. Veins lie between these spaces and anastomose with each other freely, acting as the drainage of the CCR. The corpus presents dilated hollow spaces communicating with each other in a manner resembling “a net”, and they are separated from each other by tough connective tissue septa, rare muscular cells, presenting a glomerular appearance. The distal branches of superior rectal arteries (SRA) enter the muscularis mucosae of the rectum at the level of S3, and some of the terminal branches directly run in the corpus, acting as the filler of the CCR (usually hemorrhoidal bleeding is bright red). The functional unit of hemorrhoids is the corpus cavernosum recti (CCR). proved that the contribution of the hemorrhoidal plexuses to the maximal anal basal pressure is about the 20%. The major rule of the hemorrhoids is to participate in anal continence Lestar et al. To understand hemorrhoidal disease, we should always consider the physiology of the rectum and hemorrhoidal vascularization. By analogy, comparable arterial occlusion was proposed with embolization: the “emborrhoid” technique was recently introduced by Vidal et al. However, nowadays less invasive techniques are available such as circular stapled anopexy (Longo procedure) and elective Doppler-guided hemorrhoidal artery ligation (DG-HAL). The reference surgical procedures are Milligan and Morgan’s open hemorrhoidectomy and Ferguson’s closed hemorrhoidectomy. Most patients are relieved by medical or office-based (injection sclerotherapy, rubber band ligation, infrared photocoagulation, bipolar diathermy) treatments, and surgical treatment is necessary in 10% of cases.

Hemorrhoids are the manifestation of vascular enlargement of anal cushions due to several factors.

Hemorrhoid disease (HD) is the most common anorectal condition epidemiological data are difficult to collect and range widely between 4 and 35% in the literature, depending on several variables (such as the county of the study and methodology of assessment).

Stapled hemorrhoidectomy cpt code