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For people in San Antonio who’ve been living with hemorrhoids rather than face surgery

There’s now a hemorrhoid treatment with no cutting.
No packing. No recovery stories.

Hemorrhoid artery embolization — HAE for short — shrinks internal hemorrhoids by reducing the blood flow that keeps them swollen. Nothing is cut and nothing is removed. It’s done through a pinhole in the upper thigh, you go home the same day, and most people are back to their normal routine within a day or two. The consultation to find out whether it fits you is free.

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A covered benefit under most insurance plans No referral needed Nothing enters the anal canal

Two minutes before you decide anything: what this treatment is, and why the people who’d been putting surgery off for years are the ones it was designed for.

The consultation is free

One private conversation. A straight answer.

Book through this page and the consultation — normally $245 — costs you nothing. Here’s everything it includes:

  • A private conversation with our radiology team about your symptoms and history — in a consult room, not a hallway
  • A brief, professional exam to confirm which hemorrhoids are actually causing the trouble — it takes minutes
  • A complimentary check of your insurance benefits, done for you, before anything is scheduled
  • A straight answer about whether HAE fits your situation — including “no” if it doesn’t. We turn away patients who aren’t candidates.
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It commits you to nothing. If HAE isn’t right for you, you’ll leave knowing what is.

Dr. Samy Al-Bayati guiding a catheter with a syringe during a hemorrhoid artery embolization at ARV Centers
Performed by the physician, start to finish Samy A. Al-Bayati, M.D., board-certified vascular and interventional radiologist, treating hemorrhoids with a catheter rather than a scalpel — through the top of the thigh, not the anus.

If you’ve been reading about this late at night, you’re in good company

If you’ve had hemorrhoids for years, you’ve probably done what most people do. The creams. The wipes. The fiber. Maybe a banding or two.

And when someone mentioned surgery, you read the recovery stories — and decided you could live with it a while longer.

That’s not weakness. Those stories are why this procedure exists.

The procedure

What HAE actually does.

Internal hemorrhoids are cushions of blood vessels inside the lower rectum — everyone has them. They become a problem when the blood flowing into them outruns the blood flowing out: the cushions swell, slide downward, and bleed. The arteries feeding them are branches of one vessel, the superior rectal artery, and in people with symptomatic hemorrhoids those branches carry more flow than they should. That extra inflow is the supply line that keeps the swelling and the bleeding alive.

HAE goes at that supply line directly. Through a pinhole in your upper thigh, a catheter thinner than a phone-charger cord travels to the small branches feeding the hemorrhoids. There, an interventional radiologist places tiny coils and microscopic particles, and turns the excess inflow down. The hemorrhoidal tissue stays exactly where it is — nothing is cut or removed — but with its supply reduced, it shrinks over the following weeks and the bleeding eases. Because the rectum has more than one blood supply, the healthy tissue around the hemorrhoids keeps the flow it needs.¹

Notice what HAE is not: it’s not a procedure done at the anus at all. Banding, sclerotherapy, and surgery all work from inside the anal canal — on the tissue itself. HAE works on the arteries upstream, from the inside. That’s why the muscle that gives you control is never touched, why there’s no wound to heal where you sit, and why it can help people whose banding didn’t hold.¹

The supply line, seen live Dye flowing through the superior rectal artery during an HAE at ARVC — the hemorrhoidal blush is the fine vessels filling below the tangle at the top. This is the map the doctor navigates.
A fingertip pointing to the tiny pinhole access site at the top of a patient’s thigh after hemorrhoid artery embolization
The access, actual size This is the extent of the access in the groin — less than 24 hours after the procedure.

What HAE is not

Three limits, stated before any results.

It’s for internal hemorrhoids only

External hemorrhoids have a different blood supply, and HAE wasn’t designed for them. Many people have both kinds; a brief exam at the consultation tells us which ones are actually causing your symptoms — and whether this is the right tool.

It isn’t for grade 4

HAE treats internal hemorrhoids graded 1 through 3. A hemorrhoid that stays prolapsed and won’t go back in — grade 4 — still needs surgery, and we’ll refer you for exactly that rather than sell you the wrong procedure.

It isn’t a guarantee

In the published studies, roughly 2 in 3 to 9 in 10 patients got lasting relief, and about 1 in 7 needed a second session for bleeding that came back.¹ The full numbers are below, uncropped.

Limits first, results second — that’s the order you deserve. Now the results.

See it for yourself

The supply line — before and after.

These are angiograms — X-ray pictures taken while dye flows through the arteries — from a hemorrhoid artery embolization performed here at ARVC. In the “before” images, the dark tangle at the top of each picture (arrow) is the cluster of vessels feeding the hemorrhoids, flooding in with the dye. In the “after” images, minutes later: the tangle no longer fills, the tiny coils are visible where they were placed, and the main artery is still flowing. Nothing in these pictures went anywhere near the anal canal.

Before

Angiogram before embolization: the left branch of the superior rectal artery, with a dense tangle of vessels feeding the hemorrhoids filling with dye

After

Angiogram after embolization of the left branch: the tangle no longer fills; small coils are visible in the treated branches and the artery above still carries dye
The left branch, minutes apart — before, the tangle of vessels feeding the hemorrhoids floods in with the dye; after, it no longer fills. The small squiggles are the coils, each a few millimeters long. The main artery above them is still open.

Before

Angiogram before embolization: the right branch of the superior rectal artery in the same patient, with the tangle of hemorrhoidal vessels filling with dye

After

Angiogram after both branches were treated: a wider view of the pelvis with coils in place on both sides and no hemorrhoidal blush filling
The right branch, then both sides together — the same patient. Hemorrhoids are usually fed from both sides, so both are treated. The final picture is a wider view of the pelvis: coils on both sides, and no blush left to fill.

The treatment itself, step by step

Watch one branch get turned down.

The pairs above are before and after. These four runs show the treatment itself — one branch, at ARVC, in the order it was done. Nothing here goes anywhere near the anal canal.

The blush, selectivelyThe left superior rectal artery’s anterior division, catheterized on its own. The dark cloud filling below the catheter is the hemorrhoidal blush — the excess flow feeding the cushions, with nothing else in the picture to hide it.
The first microspheresMicroscopic spheres go in to slow that flow. Watch the fine vessels running down the middle: less of the blush fills than it did a moment ago.
More, after a re-checkThe doctor shoots the picture again to see what is still filling, then adds more spheres to keep closing down the flow to the hemorrhoidal cushions.
The coils go inCoils finish the job. They keep the treated branch from reopening later — what doctors call recanalization, the vessel growing its way back to the cushions.

Angiograms from a hemorrhoid artery embolization performed at ARV Centers, San Antonio. Patient identifying information removed. Individual results vary — the study data below is the fairer way to set expectations.

The published evidence

What the studies show.

93–100%

of published procedures were technically successful — the doctors reached and treated the branches feeding the hemorrhoids.¹

63–94%

clinical success across the published studies — roughly 2 in 3 to 9 in 10 patients got lasting relief of their symptoms.¹

Zero

serious complications reported across every published study reviewed — roughly 250 patients. Minor, temporary side effects do happen; they’re listed below.¹

1 in 7

patients — 34 of about 250 — had bleeding return and were treated with a second embolization session.¹

Start with what the evidence is: a dozen published series from France, Italy, China, Russia, Turkey, and Hungary, reviewed together in the radiology literature in 2022, covering roughly 250 patients with grade 1–3 internal hemorrhoids who had already failed creams, fiber, or banding.¹ Every one reported that the procedure was safe. None reported a serious complication.

The transparent half: these are small studies with short follow-up, and there is no randomized trial yet comparing HAE head-to-head against banding or surgery — the review authors say so plainly, and so do we. Re-bleeding is the main way HAE falls short: about 1 patient in 7 needed a second session, often to treat a small feeding branch that wasn’t reached the first time.¹ Grade matters, too. In one series, 94% of grade 1–2 patients were satisfied with their improvement against 84% of grade 3 patients — both good, but not the same.¹ We’ll tell you which group your hemorrhoids are in.

The side effects, all of them: a pressure sensation like needing the restroom (tenesmus), reported in roughly a third to most patients depending on the study, lasting up to a few days and managed with ibuprofen and Tylenol; temporary abdominal or rectal discomfort; and, in one study of particle sizes, small sores at the anorectal junction with the smallest particles — graded minor, needing no more than routine care.¹ That is the list from the published series, and nothing on it involves the sphincter or bowel control.

What we won’t claim: a cure, permanence, or a number for your hemorrhoids. What we will say: for internal hemorrhoids that bleed, HAE addresses the source with no cutting and no wound, the published safety record is clean, and if it ever isn’t enough, it takes nothing off the table — a repeat, banding, and surgery all remain available afterward.

Source: 1. Talaie R, Torkian P, Dooghaie Moghadam A, Tradi F, Vidal V, Sapoval M, Golzarian J. Hemorrhoid embolization: a review of current evidences. Diagn Interv Imaging 2022;103(1):3–11 — systematic review of 12 published studies (2008–2021), ~250 patients, coils and/or particles in the superior rectal artery branches: technical success 93–100%; clinical success 63–94%; no serious complications reported; 34 of ~250 patients re-bled and were re-embolized; coils vs coils + particles 63% vs 68% (Moussa 2020, no significant difference); satisfaction 94% grade 1–2 vs 84% grade 3 (Zakharchenko 2016); tenesmus 35% (Sun 2018) to 50–87% (Küçükay 2021, particle sizes); small ischemic ulcerations with 500–700 µm particles (Küçükay 2021); anal tone preserved, no direct anorectal trauma, outpatient, return to daily routine the following day; authors call for larger randomized trials with longer follow-up. Full citation and page-claim traceability in the ARVC evidence file.

Candidacy

Who this is for — and who it isn’t.

HAE may be right for you if:

  • You have internal hemorrhoids — grade 1, 2, or 3
  • Bleeding is your main symptom — on the paper, in the bowl, or enough to leave you anemic or tired
  • Creams, fiber, and lifestyle changes haven’t been enough
  • Banding didn’t hold — or you couldn’t face a second round
  • You’ve been offered surgery and want a real alternative first
  • You’ve been told surgery is risky for you — because of blood thinners, liver disease, or other health conditions
  • You can’t afford weeks off work or away from your family for a surgical recovery

It may not be right if:

  • Your hemorrhoids are external only (we’ll check — many people have both)
  • You have a grade 4 hemorrhoid that stays prolapsed — that needs surgery, and we’ll refer you
  • Your bleeding hasn’t been evaluated yet — a colonoscopy may need to come first
  • You have certain circulation problems or advanced kidney disease

We turn away patients who aren’t candidates for what we do. Routinely.

The part nobody likes to talk about

Let’s be honest about the real reason many people wait years: nobody wants the exam.

Here’s what the consultation actually involves: a conversation, a review of your history, and yes — a brief, private, professional examination. It takes minutes. Our team does this every day; to us it’s as routine as listening to your heart. There is nothing you could show us or tell us that we haven’t seen, and nothing about it will be treated as anything other than ordinary medicine.

If it helps: many of our patients tell us the exam they dreaded for years was the easiest part of finally getting this fixed.

A private consultation and exam room at ARV Centers
A private consult room Where your conversation and exam happen — door closed, one patient at a time.

Your care team

The doctors who perform HAE here.

Hemorrhoid artery embolization at ARVC is performed by our Board Certified Vascular and Interventional Radiologists, in our own angiography suite — quietly, by a team that does embolization every day. Ask any of them anything. There is nothing you could say that they haven’t heard.

Dr. Samy Al-Bayati

Samy A. Al-Bayati, M.D.

Board Certified ·
Vascular & Interventional Radiology

English/Arabic

Dr. Arthur Joseph

Arthur S. Joseph, D.O., M.P.H.

Board Certified ·
Vascular & Interventional Radiology

Dr. Andrew Chesley

Andrew V. Chesley, M.D.

Board Certified ·
Vascular & Interventional Radiology

English/Español

After your procedure

You go home with the doctor’s cell number.

When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.

And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure.

A follow-up appointment is scheduled to check your recovery and your response to the treatment — part of the procedure here, not an extra.

Straight answers

Questions patients actually ask.

“Does anything go into my rectum during the procedure?”

No. That is the single biggest difference between HAE and every other hemorrhoid procedure. Nothing enters the anal canal at all — no scope, no band, no instrument. The entire treatment happens inside the arteries, reached through a pinhole in your upper thigh. The only time anyone examines you is at the consultation, briefly and privately, to confirm which hemorrhoids are causing the trouble.

“Will I be awake? Does it hurt?”

You’re under IV sedation — an anti-anxiety medicine plus pain medicine — relaxed and drowsy, breathing on your own. Not general anesthesia. The access point in your thigh is numbed first. Afterward, many patients feel a pressure sensation — doctors call it tenesmus — that feels like needing to use the restroom even when you don’t. In the published series it showed up in roughly a third to most patients, eased over a few days, and needed nothing more than ibuprofen and Tylenol.¹ We’ll tell you to expect it so it doesn’t worry you.

“Is it covered by insurance?”

Yes — hemorrhoid artery embolization is a covered benefit under most insurance plans, and we’re in-network with most plans. We still do a complimentary benefits check before any procedure, so there are no surprises: you’ll know exactly where you stand before you decide anything.

“When can I go back to work? When does the bleeding stop?”

Light activity for the first 48 hours — then your normal routine. Published reviews describe patients returning to daily life the day after the procedure.¹ Bleeding typically settles within one to two weeks, and the full improvement builds over four to six weeks as the hemorrhoids shrink. Driving waits until the next day: the sedation means you’ll need a driver to take you home, no exceptions.

“How is this different from banding?”

Banding treats hemorrhoids one at a time, from inside the anal canal, and larger (grade 3) hemorrhoids often aren’t good candidates. HAE works from inside the blood vessels — nothing enters the anal canal — and treats the supply feeding the whole hemorrhoidal cushion at once. If banding didn’t hold for you, or you couldn’t face a second round, that doesn’t mean this won’t work.

“How is it different from hemorrhoid surgery?”

Surgery removes the hemorrhoidal tissue, which leaves a wound in a place that has to keep working every day — that’s where the recovery stories come from. HAE removes nothing. It turns down the blood supply that keeps the tissue swollen and bleeding, and the tissue stays where it is and shrinks. No wound, no packing, no first bowel movement to dread. The transparent other half: for grade 4 hemorrhoids that stay prolapsed, surgery is still the right treatment, and we’ll refer you for it.

“Will this affect my bowel control?”

It isn’t designed to, and this is where HAE most clearly differs from surgery. Nothing is done at the anus itself, so the sphincter muscle — the muscle that gives you control — is never cut, stretched, or touched. The published reviews describe HAE as preserving anal tone precisely because there is no direct anorectal trauma.¹

“Will I need a colonoscopy first?”

Possibly — if you haven’t had one recently, or your symptoms have changed dramatically since your last one. Rectal bleeding has more than one possible cause, and hemorrhoids are only the most common. Before treating, we make sure the serious causes — including colorectal cancer — have been ruled out. If you’re due, we’ll help you get it scheduled.

“Why hasn’t my gastroenterologist or colorectal surgeon mentioned this?”

HAE is done by interventional radiologists — a different specialty with a different referral network. Nobody hid it from you; it just lives outside the world of scopes and operating rooms you’ve been seeing. The research is published in journals every specialty can read, and we’ll gladly share it with your doctor.

“Is this experimental?”

No. Hemorrhoid embolization has been performed and published since 2014, with results from roughly 250 patients across a dozen studies reviewed in the radiology literature by 2022 — and no serious complications reported in any of them.¹ What is transparently true: the trials so far are smaller and younger than the ones behind, say, knee embolization, and there is not yet a head-to-head trial against banding or surgery. We say so on this page. And it passes the test skeptics rightly apply to newer procedures: it’s a covered benefit under most insurance plans.

You’ve managed this privately for a long time. One short, ordinary appointment is how it starts getting fixed.

Pick a time on the next page — it takes about a minute. You’ll sit with a provider in a private room, discuss your options, and get a straight answer about whether HAE fits your situation. The consultation is free, and we do a complimentary benefits check before anything is scheduled. No surprises.

Book my free consultation

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(726) 216-2246