HAE vs. RBLRectal Arterial Embolization vs Band Ligation for the Treatment of Internal hemOrrhoidS

Inclusion Criteria:

1. Age ≥ 18 years and less than 90 years.
2. Ability to provide written informed consent.
3. Documented clinical history of chronic bleeding from internal hemorrhoids.
4. Documented presence of Goligher grade II-III internal hemorrhoids.
5. Failed conservative treatment for bleeding hemorrhoids (e.g. fiber supplementation, topical ointments and creams, dietary modifications, stool softeners, warm baths).
6. Able to comply with all treatments and protocol follow-up visits, in the opinion of the PI's.

Exclusion Criteria:

1. Moderate loss of kidney function, defined as estimated glomerular filtration rate of less than 45 mL/min.
2. Significant arterial atherosclerosis that would limit selective angiography.
3. Known alternative causes of GI bleeding.
4. Allergy to iodinated contrast agents.
5. Active infection or malignancy.
6. Pregnancy.
7. Active nicotine use within the last 12 months.
8. Portal hypertension/rectal varices.
9. Uncorrectable coagulopathy (INR > 2; Platelet count <100,000; PTT > 40 sec).
10. Findings on baseline CTA that adversely affect treatment, based on PI's clinical judgment, including but not limited to stenosis, occlusion, or hypoplasia of the superior and/or middle rectal arteries.