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Transarterial Microembolization Therapy for Chronic First Metatarsophalangeal Joint Pain: A New Minimally Invasive
Çağrı Erdim1, Rabia Deniz2, Tevfik Güzelbey1
1Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
Purpose:
To evaluate the feasibility, safety, and preliminary effectiveness of transarterial microembolization (TAME) for refractory first metatarsophalangeal joint (MTPJ) pain in patients with inflammatory arthritis, gout, or osteoarthritis.
Materials And Methods:
This prospective, single-center feasibility study included patients with chronic MTPJ pain refractory to maximal conservative therapy. Preprocedural radiography assessed joint space narrowing and structural changes. Under ultrasound (US) and fluoroscopic guidance, selective embolization targeting hypervascularity around the MTPJ was performed using an imipenem/cilastatin suspension. Pain severity (visual analog scale [VAS]) and weekly analgesic use were recorded at baseline and during follow-up. Twenty patients (27 feet; median age, 63 years; 4 males and 16 females) underwent TAME. The median follow-up duration was 5 months.
Results:
Median VAS scores decreased from 9 (range, 5-10) to 1 (range, 0-6) at final follow-up (P < .0001). Weekly analgesic use dropped from a median of 7 (range, 0-20) to 0 (range, 0-3) (P < .0001). One patient (3.7%) experienced transient skin discoloration, which resolved spontaneously. No major complications occurred.
Conclusions:
Based on the results of this prospective feasibility study, TAME with imipenem/cilastatin appears to be a promising and well-tolerated technique for the treatment of chronic first MTPJ pain. Larger, long-term studies are warranted to confirm these findings.
