Sheathless microcatheter: a new approach for musculoskeletal arterial embolization

Ongoing developments in interventional radiology have enabled the treatment of various musculoskeletal inflammatory disorders via super-selective embolization of abnormal areas of neovascularization. The current convention is to utilize vascular sheaths in these procedures. This study explored a single-center experience with a novel approach utilizing a sheathless microcatheter cannulation technique without the conventional vascular sheath.

A single-center retrospective chart review was conducted, including all eligible adult patients for whom a super-selective embolization was performed to treat an MSK inflammatory disorder between August 2024 and March 2025. The pre-procedural medical records and imaging were reviewed to determine satisfaction of inclusion criteria. The fluoroscopic images from the angiography suite and procedure notes were reviewed to determine technical success and immediate complications.

Twenty-seven procedures were performed for 19 patients. The average age was 47.5 ± 10 years old. The majority of patients were female (13; 68.5%). The most common procedure indication was for treatment of plantar fasciitis with 14 procedures (51.9%). The embolic material of choice was imipenem-cilastatin in all but one procedure (26; 96.3%). The commonest microcatheter size was 1.7 French (21; 77.8%), and the preferred access vessel was the common femoral artery (17; 63%). The technical success rate was 100% without immediate complications. No major post-procedural complications were encountered. Only one minor access site hematoma complication was reported.

This novel sheathless microcatheter approach was found to be feasible, safe, and effective without major complications within our limited sample size.