Clinical Research Directory

Inclusion Criteria: * Male or female, aged \>18 years * Goligher grade 2 or 3 internal hemorrhoids not amenable to rubber band ligation in the clinic setting * French bleeding score \> 5 * Rectal bleeding greater than 3 months * Colonoscopy within three years, negative for colorectal malignancy * INR \< 1.5 * Platelet count \> 150,000/dL * For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation and for an additional 6 months after intervention * Provision of signed and dated informed consent form * Stated willingness to comply with all study procedures and availability for the duration of the study Exclusion Criteria: * Current use of anticoagulants and/or DAPT * Presence of vascular disease or previous vascular intervention preventing endovascular access to the rectal arteries * Prior surgical or endovascular treatment of hemorrhoids * Prior endoscopic hemorrhoid artery ligation * Pregnancy or lactation * Known severe allergic reactions to iodinated contrast not mitigated by standard prophylaxis * Bleeding attributable to other anorectal pathology such as anal fissures, anorectal abscess, or fistula * Inflammatory bowel disease * Inflammatory vasculitis or connective tissue disease * Current participation in another clinical trial which may interfere with participation in this study * Treatment with bevacizumab within 2 months * Contraindication to surgical management of internal hemorrhoids * Primary or secondary malignancy involving the abdomen or pelvis which is likely to impact treatment * Prior pelvic radiation therapy * Prior diagnosis of portal hypertension * Major comorbidities expected to impact outcomes or increase patient risk, in the judgement of the enrolling physician