Transarterial embolization for chronic wrist pain: a preliminary study of feasibility, safety, and pain reduction
Jeeyoung Min1, Jin Ho Hwang2, Sang Woo Park1
1Department of Radiology, Konkuk University Medical Center, 120-1 Neungdong-Ro, Gwangjin-Gu, Seoul, 05030, Republic of Korea.
Background:
Abnormal neovascularization contributes to chronic musculoskeletal pain. This study aimed to evaluate the preliminary clinical outcomes based on pain reduction of transarterial embolization (TAE) for chronic wrist pain refractory to conservative management.
Methods:
This retrospective study analyzed wrist TAE performed for persistent pain caused by triangular fibrocartilage complex (TFCC) injury, de Quervain's tenosynovitis, or extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) tendinopathy. Selective arterial embolization was performed using temporary gelatin sponge particles based on the anatomical distribution of symptoms. Pain severity was evaluated using the visual analog scale (VAS) at baseline, immediately after treatment, and at 1 day, 1 week, and 1, 3, and 6 months. Technical success was defined as embolization of at least one symptomatic artery. Clinical success was defined as a reduction of more than 50% in VAS score at 6 months.
Results:
A total of 12 procedures were performed in 11 patients (median age, 40 years; interquartile range (IQR), 32-45.5). Diagnoses included TFCC injury (n = 8), de Quervain's tenosynovitis (n = 2), ECU tendinopathy (n = 1), and FCU tendinopathy (n = 1). Technical success was achieved in all procedures (100%). The median VAS score decreased from 6.5 (6.0-7.0) at baseline to 1.5 (1.0-3.25) at 6 months (p < 0.05). Clinical success was observed in 9 of 12 procedures (75.0%). Regarding safety, all adverse events were low-grade. These included transient erythematous skin reactions (Grade 1) in 58.3% (7/12) of cases, one case of puncture site pseudoaneurysm (Grade 2, 8.3%), and one case of brachial artery dissection (Grade 2, 8.3%). All events resolved without long-term complications.
Conclusions:
The results of the current study suggest that TAE is a feasible and well-tolerated treatment option for chronic refractory wrist pain. While these preliminary findings are encouraging, larger prospective studies are warranted to validate clinical effectiveness and define optimal patient selection.
