Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis

Abstract

Background

Osteoarthritis (OA) is a chronic degenerative disease significantly impacting both patient quality of life and socioeconomics. Traditional treatment options, including pharmacological and surgical interventions, are often limited. Advancements in our understanding of the pathological mechanisms behind OA indicate the involvement of pathological angiogenesis. Transarterial microembolization (TAME), a minimally invasive radiological procedure, may present an innovative therapeutic approach. This review aims to consolidate current knowledge and experiences regarding TAME as a therapeutic modality for alleviating chronic joint pain associated with OA. It explores the role of TAME, focusing on its indications, patient selection, clinical outcomes, and future perspectives. Potential complications and associated risks are systematically addressed, alongside proposed strategies for risk mitigation and effective management.

Method

The presented patient cases originate from our institution, supplemented by a thorough review of relevant literature retrieved from PubMed.

Conclusion

TAME represents a promising therapeutic approach, providing relief from the burden of joint diseases and substantially enhancing patient quality of life. Clinical outcomes emphasize the efficacy and safety of TAME in mitigating pain and improving functional capabilities in patients with chronic joint pain associated with OA. With mounting evidence of its therapeutic benefits and applicability to numerous joint-related pathologies, TAME offers a valuable addition to the arsenal of treatments for these conditions.

Key Points

• TAME is an innovative therapy for treating chronic joint pain related to OA.

• TAME is a technically challenging minimally invasive intervention requiring a high level of expertise.

• Understanding the challenges and complications of TAME can reduce risk and enhance procedural outcomes.

Citation Format

• Wilms LM, Jannusch K, Weiss D et al. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. Fortschr Röntgenstr 2024; DOI 10.1055/a-2288-5743

Zusammenfassung

Hintergrund

Arthrose ist eine chronische degenerative Gelenkerkrankung mit erheblichen Auswirkungen auf die Lebensqualität der betroffenen Patienten. Die Möglichkeiten konventioneller Behandlungsoptionen wie Schmerzmanagement und chirurgische Eingriffe kommen häufig an ihre Grenzen. Fortschritte in unserem Verständnis pathologischer Mechanismen, die der Arthrose zugrunde liegen, deuten auf die Beteiligung der pathologischen Angiogenese hin. Die transarterielle Mikroembolisation (TAME), ein minimal-invasives radiologisches Verfahren, könnte daher einen innovativen Therapieansatz darstellen. Diese Übersichtsarbeit soll den aktuellen Wissensstand und die Erfahrungen in Bezug auf die TAME als therapeutische Modalität zur Linderung chronischer Gelenkschmerzen in Zusammenhang mit Arthrose zusammenfassen. Dabei soll der Fokus auf den Indikationen, der Patientenauswahl, verfahrenstechnischen Aspekten, klinischen Ergebnissen und Anwendungsmöglichkeiten liegen. Potenzielle Komplikationen und damit verbundene Risiken sowie Strategien zur Risikominimierung werden beleuchtet.

Methode

Die vorgestellten Patientenfälle stammen aus unserem Institut und wurden durch eine sorgfältige Literaturrecherche aus PubMed ergänzt.

Schlussfolgerung

TAME ist ein vielversprechender therapeutischer Ansatz, der die Beschwerden von Gelenkerkrankungen lindert und die Lebensqualität der Patienten erheblich verbessert. Die klinischen Ergebnisse unterstreichen die Wirksamkeit und Sicherheit von TAME bei der Linderung von Schmerzen und der Verbesserung der Funktionalität bei Patienten mit chronischen Gelenkschmerzen im Zusammenhang mit Arthrose. Angesichts der zunehmenden wissenschaftlichen Belege für den therapeutischen Nutzen und die Anwendbarkeit bei zahlreichen Gelenkerkrankungen stellt die TAME eine wertvolle Ergänzung des Behandlungsspektrums für diese Erkrankungen dar.

Kernaussagen

• TAME ist eine innovative Therapie zur Behandlung chronischer Gelenkschmerzen im Zusammenhang mit Arthrose.

• Die TAME ist ein technisch anspruchsvoller, minimalinvasiver Eingriff, der eine Expertise erfordert.

• Ein umfassendes Verständnis von Komplikationen mindert Risiken und optimiert die Behandlungsergebnisse des Verfahrens.

Keywords

embolization - muscular - knee - TAME - genicular artery embolization - osteoarthritis

Publication History

Received: 21 November 2023

Accepted after revision: 09 March 2024

Article published online:
13 May 2024

• References

• 1 Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci 2013; 5: 30-38 DOI: 10.4103/0975-7406.106561. (PMID: 23559821)
• 2 Litwic A, Edwards MH, Dennison EM. et al. Epidemiology and burden of osteoarthritis. Br Med Bull 2013; 105: 185-199 DOI: 10.1093/bmb/lds038. (PMID: 23337796)
• 3 McAlindon TE, LaValley MP, Harvey WF. et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA 2017; 317: 1967-1975 DOI: 10.1001/jama.2017.5283.
• 4 Okuno Y, Matsumura N, Oguro S. Transcatheter Arterial Embolization Using Imipenem/Cilastatin Sodium for Tendinopathy and Enthesopathy Refractory to Nonsurgical Management. J Vasc Interv Radiol 2013; 24: 787-792 DOI: 10.1016/j.jvir.2013.02.033. (PMID: 23707086)
• 5 Klit J, Jacobsen S, Rosenlund S. et al. Total Knee Arthroplasty in Younger Patients Evaluated by Alternative Outcome Measures. J Arthroplasty 2014; 29: 912-917 DOI: 10.1016/j.arth.2013.09.035. (PMID: 24269097)
• 6 Parvizi J, Nunley RM, Berend KR. et al. High Level of Residual Symptoms in Young Patients After Total Knee Arthroplasty. Clin Orthop Relat Res 2014; 472: 133-137 DOI: 10.1007/s11999-013-3229-7. (PMID: 24061845)
• 7 Ashraf S, Wibberley H, Mapp PI. et al. Increased vascular penetration and nerve growth in the meniscus: a potential source of pain in osteoarthritis. Ann Rheum Dis 2011; 70: 523-529 DOI: 10.1136/ard.2010.137844. (PMID: 21081524)
• 8 Bonnet CS. Osteoarthritis, angiogenesis and inflammation. Rheumatology 2005; 44: 7-16 DOI: 10.1093/rheumatology/keh344. (PMID: 15292527)
• 9 Goldman DT, Piechowiak R, Nissman D. et al. Current Concepts and Future Directions of Minimally Invasive Treatment for Knee Pain. Curr Rheumatol Rep 2018; 20: 54 DOI: 10.1007/s11926-018-0765-x. (PMID: 30033492)
• 10 Casadaban LC, Mandell JC, Epelboym Y. Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes. Cardiovasc Intervent Radiol 2021; 44: 1-9 DOI: 10.1007/s00270-020-02687-z. (PMID: 33135117)
• 11 Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis. Nat Rev Rheumatol 2012; 8: 390-398 DOI: 10.1038/nrrheum.2012.80. (PMID: 22641138)
• 12 Cherifi C, Latourte A, Vettorazzi S. et al. Inhibition of sphingosine 1-phosphate protects mice against chondrocyte catabolism and osteoarthritis. Osteoarthritis Cartilage 2021; 29: 1335-1345 DOI: 10.1016/j.joca.2021.06.001. (PMID: 34144150)
• 13 Suri S, Gill SE, de Camin SM. et al. Neurovascular invasion at the osteochondral junction and in osteophytes in osteoarthritis. Ann Rheum Dis 2007; 66: 1423-1428 DOI: 10.1136/ard.2006.063354.
• 14 Fransès RE, McWilliams DF, Mapp PI. et al. Osteochondral angiogenesis and increased protease inhibitor expression in OA. Osteoarthritis Cartilage 2010; 18: 563-571 DOI: 10.1016/j.joca.2009.11.015. (PMID: 20060952)
• 15 Fenwick SA, Gregg PJ, Rooney P. Osteoarthritic cartilage loses its ability to remain avascular. Osteoarthritis Cartilage 1999; 7: 441-452 DOI: 10.1053/joca.1998.0238. (PMID: 10489316)
• 16 Eisenstein R, Sorgente N, Soble LW. et al. The Resistance of Certain Tissues to Invasion. Am J Pathol 1973; 73: 765-774 (PMID: 4129060)
• 17 Walsh DA, Bonnet CS, Turner EL. et al. Angiogenesis in the synovium and at the osteochondral junction in osteoarthritis. Osteoarthritis Cartilage 2007; 15: 743-751 DOI: 10.1016/j.joca.2007.01.020. (PMID: 17376709)
• 18 Little MW, Gibson M, Briggs J. et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis. Cardiovasc Intervent Radiol 2021; 44: 931-940 DOI: 10.1007/s00270-020-02764-3.
• 19 Okuno Y, Korchi AM, Shinjo T. et al. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis. Cardiovasc Intervent Radiol 2015; 38: 336-343 DOI: 10.1007/s00270-014-0944-8.
• 20 Okuno Y, Korchi AM, Shinjo T. et al. Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment. J Vasc Interv Radiol 2017; 28: 995-1002 DOI: 10.1016/j.jvir.2017.02.033. (PMID: 28365171)
• 21 Okuno Y, Iwamoto W, Matsumura N. et al. Clinical Outcomes of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment. J Vasc Interv Radiol JVIR 2017; 28: 161-167.e1 DOI: 10.1016/j.jvir.2016.09.028.
• 22 Iwamoto W, Okuno Y, Matsumura N. et al. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up. J Shoulder Elbow Surg 2017; 26: 1335-1341 DOI: 10.1016/j.jse.2017.03.026.
• 23 Choi JW, Ro DH, Chae HD. et al. The Value of Preprocedural MR Imaging in Genicular Artery Embolization for Patients with Osteoarthritic Knee Pain. J Vasc Interv Radiol 2020; 31: 2043-2050 DOI: 10.1016/j.jvir.2020.08.012.
• 24 Wang K, Zhou J, Chen X-S. et al. Transcatheter arterial embolization for postoperative arterial complications after pelvic or hip surgery. Diagn Interv Radiol 2019; 25: 219-224 DOI: 10.5152/dir.2019.18212. (PMID: 31063141)
• 25 Kishore S, Friedman T, Madoff DC. Update on Embolization Therapies for Hepatocellular Carcinoma. Curr Oncol Rep 2017; 19: 40 DOI: 10.1007/s11912-017-0597-2. (PMID: 28421483)
• 26 Bagla S, Piechowiak R, Hartman T. et al. Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol 2020; 31: 1096-1102 DOI: 10.1016/j.jvir.2019.09.018. (PMID: 31837946)
• 27 Marmagkiolis K, Sardar P, Mustapha JA. et al. Transpedal Access for the Management of Complex Peripheral Artery Disease. J Invasive Cardiol 2017; 29: 425-429 (PMID: 29207364)
• 28 Katoh M, Schott P, Freyhardt P. et al. Transarterial Periarticular Embolization (TAPE): Indications and Initial Experience in Germany. Fortschr Röntgenstr 2020; 192: 1046-1052 DOI: 10.1055/a-1212-6149. (PMID: 32882726)
• 29 Padia SA, Genshaft S, Blumstein G. et al. Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis. JB JS Open Access 2021; 6: e21.00085 DOI: 10.2106/JBJS.OA.21.00085.
• 30 Lin HY, Liang KW, Wang B. et al. Challenges and complications and their management of the transarterial microembolization for chronic musculoskeletal pain. Eur Radiol 2023; DOI: 10.1007/s00330-023-10328-5.
• 31 Bhatia S, Jalaeian H, Kumar J. et al. Two-year outcomes comparing Embosphere® microspheres versus Imipenem Cilastatin for genicular artery embolization in patients with moderate to severe knee osteoarthritis. The Knee 2023; 41: 38-47 DOI: 10.1016/j.knee.2022.12.008.
• 32 Inui S, Yoshizawa S, Shintaku T. et al. Intra-Arterial Infusion of Imipenem/Cilastatin Sodium through a Needle Inserted into the Radial Artery as a New Treatment for Refractory Trapeziometacarpal Osteoarthritis. J Vasc Interv Radiol JVIR 2021; 32: 1341-1347 DOI: 10.1016/j.jvir.2021.06.024.
• 33 Torkian P, Golzarian J, Chalian M. et al. Osteoarthritis-Related Knee Pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9 DOI: 10.1177/23259671211021356.
• 34 Ghelfi J, Soulairol I, Stephanov O. et al. Feasibility of Neovessel Embolization in a Large Animal Model of Tendinopathy: Safety and Efficacy of Various Embolization Agents. J Pers Med 2022; 12: 1530 DOI: 10.3390/jpm12091530.
• 35 Waldenberger P, Chemelli A, Hennerbichler A. et al. Transarterial embolization for the management of hemarthrosis of the knee. Eur J Radiol 2012; 81: 2737-2740 DOI: 10.1016/j.ejrad.2011.11.016. (PMID: 22154590)
• 36 Hwang JH, Park SW, Kim KH. et al. Early Results of Transcatheter Arterial Embolization for Relief of Chronic Shoulder or Elbow Pain Associated with Tendinopathy Refractory to Conservative Treatment. J Vasc Interv Radiol 2018; 29: 510-517 DOI: 10.1016/j.jvir.2017.11.013. (PMID: 29477621)
• 37 O’Grady A, Welsh L, Gibson M. et al. Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis. Cardiovasc Intervent Radiol 2022; 45: 80-90 DOI: 10.1007/s00270-021-02978-z.
• 38 Lee SH, Hwang JH, Kim DH. et al. Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis. Cardiovasc Intervent Radiol 2019; 42: 1530-1536 DOI: 10.1007/s00270-019-02289-4. (PMID: 31338552)
• 39 Bagla S, Piechowiak R, Sajan A. et al. Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis. J Vasc Interv Radiol 2022; 33: 2-10.e2 DOI: 10.1016/j.jvir.2021.09.019.
• 40 Kerr R, Resnick D, Pineda C. et al. Osteoarthritis of the glenohumeral joint: a radiologic-pathologic study. AJR Am J Roentgenol 1985; 144: 967-972 DOI: 10.2214/ajr.144.5.967. (PMID: 3872581)
• 41 Fernández Martínez AM, Baldi S, Alonso-Burgos A. et al. Mid-Term Results of Transcatheter Arterial Embolization for Adhesive Capsulitis Resistant to Conservative Treatment. Cardiovasc Intervent Radiol 2021; 44: 443-451 DOI: 10.1007/s00270-020-02682-4.
• 42 Okuno Y, Oguro S, Iwamoto W. et al. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg 2014; 23: e199-e206 DOI: 10.1016/j.jse.2013.12.014.
• 43 Haara MM, Heliövaara M, Kröger H. et al. Osteoarthritis in the Carpometacarpal Joint of the Thumb: Prevalence and Associations with Disability and Mortality. JBJS 2004; 86: 1452
• 44 Patel TJ, Beredjiklian PK, Matzon JL. Trapeziometacarpal joint arthritis. Curr Rev Musculoskelet Med 2012; 6: 1-8 DOI: 10.1007/s12178-012-9147-6. (PMID: 23242976)
• 45 Kalichman L, Hernández-Molina G. Hand osteoarthritis: an epidemiological perspective. Semin Arthritis Rheum 2010; 39: 465-476 DOI: 10.1016/j.semarthrit.2009.03.001. (PMID: 19482338)
• 46 Kloppenburg M, Kroon FP, Blanco FJ. et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis 2019; 78: 16-24 DOI: 10.1136/annrheumdis-2018-213826. (PMID: 30154087)
• 47 Murphy NJ, Eyles JP, Hunter DJ. Hip Osteoarthritis: Etiopathogenesis and Implications for Management. Adv Ther 2016; 33: 1921-1946 DOI: 10.1007/s12325-016-0409-3. (PMID: 27671326)
• 48 Correa MP, Motta-Leal-Filho JM, Junior EB. et al. 6-Month Follow-up of Lateral Femoral Circumflex Artery Embolization to Control Pain Related to Hip Osteoarthritis and Greater Trochanteric Pain Syndrome. Cardiovasc Intervent Radiol 2022; 45: 1710-1715 DOI: 10.1007/s00270-022-03253-5. (PMID: 36002538)
• 49 Herrera-Pérez M, Valderrabano V, Godoy-Santos AL. et al. Ankle osteoarthritis: comprehensive review and treatment algorithm proposal. EFORT Open Rev 2022; 7: 448-459 DOI: 10.1530/EOR-21-0117. (PMID: 35900210)