Blood supply of the anal canal in patients with chronic hemorrhoids

Abstract

The most important factors in the development of chronic haemorrhoids today are considered to be the combination of two factors (vascular and mechanical) that lead to the development of hemorrhoids. The underlying vascular factor is the vascular dysfunction, providing arterial blood flow through the arteries to the cavernous bodies and outflow through the cavernous veins, which leads to dilation of cavernous bodies and the formation of vascular malformations.There were performed clinical examination and treatment of 140 patients with chronic hemorrhoids of stage III-IV according to Goligher. The features of arterial blood supply of the anal canal were evaluated by transrectal ultrasound examination.It was found that there was no clear linear relationship between the number of anal arteries with increased blood flow and the number of hemorrhoidal nodes in the patient. Each node was supplied with blood from one or two arteries: the node placed at 11 o'clock had blood supply from the arteries visualized at 10 and 11 o'clock, the node at 3 o'clock - arteries at 3 and 5 o'clock, the node at 7 o'clock - arteries at 7 and 9 o'clock. The arteries were most frequently visualized at the first (89.4%), the third (93.3%), the seventh (88.8%) and the eleventh (93.4%) hours. With less frequency the hemodynamically significant arteries were visualized at the fifth (65.0%), the ninth (62.8%) and the tenth (66.7%) hours. The arteries that were suppliing blood hemorrhoidal vessels were located in the internal sphincter at a depth of 5 to 10 mm. In the area of 3, 7 and 11 hours, they overlapped with a mosaic pattern that corresponded to the localization of the cavernous body and resembled an arteriovenous fistula according to the СDS.