Transcatheter arterial embolization (TAE) produced clinically meaningful pain reductions in three-quarters of patients with chronic wrist pain, according to a recent study.
The finding suggests that the emerging interventional radiology procedure could be a new option for patients who have exhausted conservative management, noted lead author Jeeyoung Min, MD, PhD, of Konkuk University Medical Center in Seoul, South Korea, and colleagues.
"In this exploratory pilot study, TAE with temporary gelatin sponge particles was technically feasible and safe, with favorable preliminary pain reduction in selected patients with chronic refractory wrist pain," they wrote. The study was published May 20 in CVIR Endovascular.
Transcatheter arterial embolization is a minimally invasive procedure in which an interventional radiologist threads a catheter through blood vessels to selectively block blood flow to a targeted area using embolic materials. The procedure reduces inflammation and decreases pain by limiting abnormal blood supply to affected tissues.
The procedure has been extensively studied for knee osteoarthritis and has shown promise at other sites including the shoulder and elbow, the authors noted. Evidence on its use for chronic wrist pain is limited, however, with prior studies focused on hand osteoarthritis and finger joints, they noted.
To further assess its potential benefits, researchers analyzed outcomes among 11 patients (median age 40 years old) who underwent 12 procedures at their center between July 2020 and May 2021. Patients were refractory to at least three months of conservative treatment including medication, physical therapy, and local interventions.
The researchers evaluated pain severity using the visual analog scale (VAS) at baseline, immediately after treatment, and at one day, one week, and one, three, and six months. Technical success was defined as embolization of at least one symptomatic artery, while clinical success was defined as a reduction of more than 50% in VAS score at six months.
According to the results, technical success was achieved in all 12 procedures. Median VAS scores fell from 6.5 at baseline to 1.5 at six months. Clinical success was achieved in nine of 12 procedures (75%), including 75% of subjects with persistent pain caused by triangular fibrocartilage complex (TFCC) tears and 100% of patients with de Quervain's tenosynovitis and tendinopathy. Of the three clinical failures, two had a history of prior wrist arthroscopy, compared with only one patient in the success group, the researchers reported.
A 44-year-old woman with TFCC injury treated by transcatheter arterial embolization (TAE). a) Right brachial arteriography via common femoral artery access with a 5-Fr catheter demonstrates hyperstaining on the ulnar side of the wrist joint (white circle). b) An ulnar artery branch is superselected with a 1.9-Fr microcatheter, showing hypervascular staining corresponding to the pain site (white arrow). c) Delayed-phase angiography reveals early venous drainage (white arrow) adjacent to the hyperstaining, a finding often observed in TAE and considered an additional marker for embolization. d) Final angiography after injection of 0.5 mL quick-soluble gelatin sponge particles (QS-GSPs) demonstrates resolution of the hyperstaining (white circle). The VAS pain score improved from 7 at baseline to 1 at six months.CVIR Endovascular
The authors noted that on angiography, areas of abnormal blood vessel growth lined up with where patients reported pain and with findings seen on preprocedural ultrasound. Moreover, these patterns held across multiple wrist conditions, suggesting that neovascularization may be a common driver of pain in both degenerative (Quervain’s tenosynovitis) conditions and overuse-related injuries (TFCC tears).
"Further prospective studies are warranted to establish clinical efficacy and optimize patient selection," they wrote.
The full study is available here.
