Radiology Konkuk University Hospital Konkuk University Hospital, Republic of Korea
Purpose: To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) using a new quickly soluble gelatin sponge particle for alleviation of chronic pain in various musculoskeletal conditions.
Material and Methods: We enrolled 29 patients (34 cases) who underwent TAE in the period from August to December 2019 to treat chronic knee pain (22 cases of osteoarthritis), elbow pain (4 cases of lateral and 5 of medial epicondylitis), ankle pain (2 cases of ankle sprain), or shoulder pain (1 case of adhesive capsulitis) refractory to conservative treatment. Access was obtained via the common femoral artery for treatment of knee or ankle pain and via the radial artery for treatment of shoulder or elbow pain. After detecting an abnormal enhancement and its causative feeding artery around the painful area on arteriography using a 4- or 5-F angiographic catheter, superselective arteriography of the corresponding artery was performed using a coaxial 1.9-F microcatheter. A quickly soluble gelatin sponge particle with a diameter of 50–150 µm was used in all cases. The endpoint of embolization was near-stasis of the feeding artery. Technical success was defined as superselective embolization of at least one feeding artery to the painful area. The degree of pain was evaluated on a 10-point visual analog scale (VAS). Clinical success was defined as decrease in VAS score of more than 50% from baseline. Adverse events were assessed.
Results: The technical success rate was 100% (34/34). The mean amount of embolic agent used was 4.1 ± 2.1 mL. The average number of arteries per embolization was 1.8 ± 0.8. The follow-up duration was 3 months for 24 cases and 1 month for 10 cases. The mean VAS scores at baseline; immediately after TAE; and 1 day, 1 week, and 1 and 3 months after TAE were 6.6, 3.1, 4.1, 2.4, 1.9, and 1.5, respectively (P < .001, postprocedure vs. baseline). Although the mean pain score decreased gradually, it elevated transiently from the value immediately after the procedure to 1 day after the procedure. The clinical success rate was 82.4% (28/34). Transient erythematous skin reactions were found in 20 cases (58.8%), and hematoma at the puncture site occurred in three cases (8.8%).
Conclusions: TAE using a new quickly soluble gelatin sponge particle is effective for relieving pain in various musculoskeletal conditions. However, pain may increase temporarily from the day of the procedure to the day after. In addition, transient erythematous skin reactions in the treated area may occur.