Transarterial embolization for the management of hemarthrosis of the knee

The purpose of this retrospective study was to evaluate transarterial catheter embolization (TAE) for the management of hemarthrosis of the knee in 35 patients treated at two different hospitals.

From June 1998 through January 2011, 35 patients (22 men and 13 women, mean age 57 years) underwent TAE for hemarthrosis of the knee using polyvinyl alcohol particles (PVA particles), multi-curled 0.018 in. microcoils or a combination of both. In one patient a detachable microcoil was used. Hemarthrosis developed after arthroscopy in 9, after trauma in 3, after arthroplasty in 18 and after sepsis in 2 patients. 2 patients had severe gonarthrosis and in one patient hemarthrosis was due to Marfan's syndrome. Angiographies showed abnormal and increased vasculature in 23 patients, one or more pseudoaneurysms in 8 and arterio-venous fistula in 2 patients. One patient showed both, pseudoaneurysm and hypervascularization and another one pseudoaneurysm and arterio-venous fistula.

Technical success was achieved in 100%. None of the patients developed procedure-related complications such as periarticular skin- or tissue necrosis, including a patient who underwent TAE of two different bleeding sources in two consecutive sessions. Clinical success was 93.4%. Two patients showed recurrent swelling of the knee, 377 and 824 days after TAE respectively. However, only one of them required secondary TAE because of abnormal and increased vasculature.

In our view, TAE is the treatment of choice for the management of hemarthrosis of the knee. It is an effective and minimally invasive technique with very low complication rates.