Hemorrhoidal Artery Embolization: Longitudinal Impact On Symptoms (HELIOS)

Inclusion Criteria: * Age 18 to 90 years * Ability to give written informed consent and to comply with the follow-up visits * Symptomatic hemorrhoidal disease with French Bleeding Score (FBS) of at least four out of nine * Refusal of or contraindication to surgery * Refusal of or contraindication to other minimally invasive hemorrhoid treatments * Grade I to III hemorrhoids * Previous anoscopy or colonoscopy demonstrating internal hemorrhoids within 1 year * Supply of the CCR from either the SRA or MRA on intra-procedural angiogram prior to embolization Exclusion Criteria: * Asymptomatic patients * Patients who ever had previous colorectal surgery * Grade IV hemorrhoids * Colorectal disease other than hemorrhoids that could result in bleeding * Anatomic findings on CTA that would preclude successful embolization * Contraindication to iodinated contrast * Inability to give written informed consent * Active infection or malignancy * Recent (within 12 months) or active cigarette use * History of inflammatory bowel disease * Uncorrectable bleeding diathesis * Presence of portal hypertension or rectal varices seen on pre-procedure CTA or anoscopy/colonoscopy * No SRA or MRA supply to the CCR seen intra-procedural angiogram