Embolización arterial selectiva
Barra lateral del artículo
Publicado:
oct 27, 2025
Palabras clave:
Emboloterapia, embolización arterial selectiva, embolización de arterias geniculares, osteoartritis, gonartrosis, reemplazo total de rodilla doloroso, capsulitis adhesiva
Contenido principal del artículo
Resumen
La osteoartritis de rodilla es la artropatía degenerativa más prevalente y una de las causas principales de dolor crónico y discapacidad. Su fisiopatología involucra desgaste condral, inflamación sinovial, angiogénesis patológica y neoinervación sensorial. El tratamiento varía desde medidas conservadoras hasta la artroplastia. un grupo de pacientes aún no candidatos quirúrgicos se beneficiarían de opciones mínimamente invasivas. La embolización arterial genicular surge como una alternativa prometedora al reducir la neovascularización y, de este modo, el dolor. Se han comunicado mejoras clínicas superiores al 70% y un perfil de seguridad favorable. Su indicación se ha extendido al dolor persistente después de una artroplastia y a otras entidades nosológicas musculoesqueléticas crónicas (capsulitis adhesiva), con resultados alentadores. Pese a la evidencia inicial prometedora, se necesitan ensayos controlados y un seguimiento prolongado para definir su rol en el manejo de la osteoartritis y otras enfermedades musculoesqueléticas y, de esta manera, poder incluirla en guías de tratamiento.
Descargas
La descarga de datos todavía no está disponible.
Detalles del artículo
Cómo citar
Bertoni, H. G., Bertoni, V., Autorino, C. M., & Manfrin, F. (2025). Embolización arterial selectiva. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(5), 472-480. https://doi.org/10.15417/issn.1852-7434.2025.90.5.2226
Número
Sección
Actualización
Derechos de autor 2025 Revista de la Asociación Argentina de Ortopedia y Traumatología
La aceptación del manuscrito por parte de la revista implica la no presentación simultánea a otras revistas u órganos editoriales. La RAAOT se encuentra bajo la licencia Creative Commons 4.0. Atribución-NoComercial-CompartirIgual (http://creativecommons.org/licenses/by-nc-sa/4.0/deed.es). Se puede compartir, copiar, distribuir, alterar, transformar, generar una obra derivada, ejecutar y comunicar públicamente la obra, siempre que: a) se cite la autoría y la fuente original de su publicación (revista, editorial y URL de la obra); b) no se usen para fines comerciales; c) se mantengan los mismos términos de la licencia.
En caso de que el manuscrito sea aprobado para su próxima publicación, los autores conservan los derechos de autor y cederán a la revista los derechos de la publicación, edición, reproducción, distribución, exhibición y comunicación a nivel nacional e internacional en las diferentes bases de datos, repositorios y portales.
Se deja constancia que el referido artículo es inédito y que no está en espera de impresión en alguna otra publicación nacional o extranjera.
Por la presente, acepta/n las modificaciones que sean necesarias, sugeridas en la revisión por los pares (referato), para adaptar el trabajo al estilo y modalidad de publicación de la Revista.
Citas
1. Leifer VP, Katz JN, Losina E. The burden of OA-health services and economics. Osteoarthritis Cartilage 2022;30(1):10-6. https://doi.org/10.1016/j.joca.2021.05.007
2. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018;100(17):1455-60. https://doi.org/10.2106/JBJS.17.01617
3. Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis. Nat Rev Rheumatol 2012;8(7):390-8. https://doi.org/10.1038/nrrheum.2012.80
4. Talaie R, Torkian P, Clayton A, Wallace S, Cheung H, Chalian M, et al. Emerging targets for the treatment of osteoarthritis: new investigational methods to identify neo-vessels as posible targets for embolization. Diagnostics (Basel) 2022;12(6):1403. https://doi.org/10.3390/diagnostics12061403
5. Kishore S, Sheira D, Malin ML, Trost DW, Mandl LA. Transarterial embolization for the treatment of chronic musculoskeletal pain: a systematic review of indications, safety, and efficacy. ACR Open Rheumatol 2022;4(3):209-
17. https://doi.org/10.1002/acr2.11383
6. Sapoval M, Querub C, Pereira H, Pellerin O, Boeken T, Di Gaeta A, et al. Genicular artery embolization for knee osteoarthritis: results of the LipioJoint-1 trial. Diagn Interv Imaging 2024;105(4):144-50. https://doi.org/10.1016/j.diii.2023.12.003
7. Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol 2017;28(7):995-1002. https://doi.org/10.1016/j.jvir.2017.02.033
8. Okuno Y, Korchi AM, Shinjo T, Kato S. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol 2015;38(2):336-43. https://doi.org/10.1007/s00270-014-0944-8
9. Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol 2020;31(7):1096-102. https://doi.org/10.1016/j.jvir.2019.09.018
10. Little MW, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) using permanent microspheres: interim analysis. Cardiovasc Intervent Radiol 2021;44(9):1340-8. https://doi.org/10.1007/s00270-020-02764-3
11. Taslakian B, Miller LE, Mabud TS, Macaulay W, Samuels J, Attur M, et al. Genicular artery embolization for treatment of knee osteoarthritis pain: systematic review and meta-analysis. Osteoarthr Cartil Open 2023;5(2):100342. https://doi.org/10.1016/j.ocarto.2023.100342
12. Cusumano LR, Sparks HD, Masterson KE, Genshaft SJ, Plotnik AN, Padia SA. Genicular artery embolization for treatment of symptomatic knee osteoarthritis: 2-year outcomes from a prospective IDE trial. J Vasc Interv Radiol 2024;35(12):1768-75. https://doi.org/ 10.1016/j.jvir.2024.08.028
13. Baerlocher MO, Nikolic B, Sze DY. Adverse event classification: clarification and validation of the Society of Interventional Radiology specialty-specific system. J Vasc Interv Radiol 2023;34(1):1-3. https://doi.org/10.1016/j.jvir.2022.10.011
14. Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman-Hill R. Chronic pain after total knee arthroplasty. EFORT Open Rev 2018;3(8):461-70. https://doi.org/10.1302/2058-5241.3.180004
15. Wylde V, Bertram W, Sanderson E, Noble S, Howells N, Peters TJ, et al. The STAR care pathway for patients with pain at 3 months after total knee replacement: a multicentre, pragmatic, randomised, controlled trial. Lancet Rheumatol 2022;4(3):e188-97. https://doi.org/10.1016/S2665-9913(21)00371-4
16. Chau Y, Roux C, Gonzalez JF, Breuil V, Bernard de Dompsure R, Fontas E, et al. Effectiveness of geniculate artery embolization for chronic pain after total knee replacement: a pilot study. J Vasc Interv Radiol 2023;34(10):1725-33. https://doi.org/10.1016/j.jvir.2023.06.026
17. Chau Y, Roux C, Breuil V, Trojani C, Gonzalez JF, Amoretti N, et al. Endovascular occlusion of neovascularization as a treatment for persistent pain after total knee arthroplasty. Cardiovasc Intervent Radiol 2020;43(5):787-90. https://doi.org/10.1007/s00270-020-02449-x.
18. Park CN, White PB, Meftah M, Ranawat AS, Ranawat CS. Diagnostic algorithm for residual pain after total knee arthroplasty. Orthopedics 2016;39(2):e246-52. https://doi.org/10.3928/01477447-20160119-06
19. McDowell M, Park A, Gerlinger TL. The painful total knee arthroplasty. Orthop Clin North Am 2016;47(2):317-26. https://doi.org/10.1016/j.ocl.2015.09.008
20. Paish HL, Baldock TE, Gillespie CS, Del Carpio Pons A, Mann DA, Deehan DJ, et al. Chronic, active inflammation in patients with failed total knee replacements undergoing revision surgery. J Orthop Res 2019;37(11):2316-24. https://doi.org/10.1002/jor.24398
21. Cornman-Homonoff J, Kishore SA, Waddell BS, Kesler J, Mandl LA, Westrich GH, et al. Genicular artery embolization for refractory hemarthrosis following total knee arthroplasty: technique, safety, efficacy, and patient- reported outcomes. J Vasc Interv Radiol 2021;32(8):1128-35. https://doi.org/10.1016/j.jvir.2021.04.020
22. Melian CM, Giannopoulos S, Tsouknidas I, Volteas P, Virvilis D, Koullias GJ. Geniculate artery endovascular embolization post-total knee arthroplasty for hemarthrosis treatment: a systematic review of the literature. J Endovasc Ther 2024;31(6):1158-64. https://doi.org/10.1177/15266028231157642
23. Autorino CM, Lauritto D, Escobar G, Alvarez Salinas E, San Román A, Santini Araujo E, et al. Hemartrosis recurrente en paciente con reemplazo total de rodilla. Revista Cirugía Reconstructiva de Cadera y Rodilla 2015;1(2): 122-9. Disponible en: https://acaro.org.ar/acarorevista/files/revistas/vol-1-nro-2/Vol-1-Nro-2-Agosto-2015.pdf
24. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008;1(3- 4):180-9. https://doi.org/10.1007/s12178-008-9031-6
25. Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow 2017;9(2):75-84. https://doi.org/10.1177/1758573216676786
26. Okuno Y, Iwamoto W, Matsumura N, Oguro S, Yasumoto T, Kaneko T, et al. Clinical outcomes of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. J Vasc Interv Radiol 2017;28(2):161-7.e1. https://doi.org/10.1016/j.jvir.2016.09.028
27. Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg 2014;23(9):e199-206. https://doi.org/10.1016/j.jse.2013.12.014
28. Fernández Martínez AM, Baldi S, Alonso-Burgos A, López R, Vallejo-Pascual ME, Cuesta Marcos MT, et al. Mid-term results of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. Cardiovasc Intervent Radiol 2021;44(3):443-51. https://doi.org/10.1007/s00270-020-02682-4
29. Xu Y, Bonar F, Murrell GAC. Enhanced expression of neuronal proteins in idiopathic frozen shoulder. J Shoulder Elbow Surg 2012;21(10):1391-7. https://doi.org/10.1016/j.jse.2011.08.046
30. Hwang JH, Park SW, Kim KH, Lee SJ, Oh KS, Chung SW, et al. Early results of transcatheter arterial embolization for relief of chronic shoulder or elbow pain associated with tendinopathy refractory to conservative treatment. J Vasc Interv Radiol 2018;29(4):510-7. https://doi.org/10.1016/j.jvir.2017.11.013
31. Bagla S, Nagda S, Piechowiak R, Orlando J, Sajan A, Isaacson A. Results from a United States investigational device study of adhesive capsulitis embolization in the treatment of shoulder pain: the adhesive capsulitis embolization study. J Vasc Interv Radiol 2022;33(2):177-82. https://doi.org/10.1016/j.jvir.2021.10.031
32. Okuno Y, Yasumoto T, Koganemaru M, Suyama Y, Nishiofuku H, Horikawa M, et al. Transarterial embolization of neovascularity for refractory nighttime shoulder pain: a multicenter, open-label, feasibility trial. J Vasc Interv Radiol 2022;33(12):1468-75.e8. https://doi.org/10.1016/j.jvir.2022.08.016
33. Lopes PM, Cavalheiro F, Gonçalves R, Sousa F, Sousa P. Musculoskeletal embolization: endovascular treatment of adhesive capsulitis. ARP Rheumatol 2024;3(2):159-61. PMID: 38956999
34. Lanciego C, Puentes-Gutierrez A, Sánchez-Casado M, Cifuentes-Garcia I, Fernández-Tamayo A, Dominguez- Paillacho D, et al. Transarterial embolization for adhesive capsulitis of the shoulder: midterm outcomes on function and pain relief. J Vasc Interv Radiol 2024;35(4):550-7. https://doi.org/10.1016/j.jvir.2023.12.572
2. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018;100(17):1455-60. https://doi.org/10.2106/JBJS.17.01617
3. Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis. Nat Rev Rheumatol 2012;8(7):390-8. https://doi.org/10.1038/nrrheum.2012.80
4. Talaie R, Torkian P, Clayton A, Wallace S, Cheung H, Chalian M, et al. Emerging targets for the treatment of osteoarthritis: new investigational methods to identify neo-vessels as posible targets for embolization. Diagnostics (Basel) 2022;12(6):1403. https://doi.org/10.3390/diagnostics12061403
5. Kishore S, Sheira D, Malin ML, Trost DW, Mandl LA. Transarterial embolization for the treatment of chronic musculoskeletal pain: a systematic review of indications, safety, and efficacy. ACR Open Rheumatol 2022;4(3):209-
17. https://doi.org/10.1002/acr2.11383
6. Sapoval M, Querub C, Pereira H, Pellerin O, Boeken T, Di Gaeta A, et al. Genicular artery embolization for knee osteoarthritis: results of the LipioJoint-1 trial. Diagn Interv Imaging 2024;105(4):144-50. https://doi.org/10.1016/j.diii.2023.12.003
7. Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol 2017;28(7):995-1002. https://doi.org/10.1016/j.jvir.2017.02.033
8. Okuno Y, Korchi AM, Shinjo T, Kato S. Transcatheter arterial embolization as a treatment for medial knee pain in patients with mild to moderate osteoarthritis. Cardiovasc Intervent Radiol 2015;38(2):336-43. https://doi.org/10.1007/s00270-014-0944-8
9. Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol 2020;31(7):1096-102. https://doi.org/10.1016/j.jvir.2019.09.018
10. Little MW, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) using permanent microspheres: interim analysis. Cardiovasc Intervent Radiol 2021;44(9):1340-8. https://doi.org/10.1007/s00270-020-02764-3
11. Taslakian B, Miller LE, Mabud TS, Macaulay W, Samuels J, Attur M, et al. Genicular artery embolization for treatment of knee osteoarthritis pain: systematic review and meta-analysis. Osteoarthr Cartil Open 2023;5(2):100342. https://doi.org/10.1016/j.ocarto.2023.100342
12. Cusumano LR, Sparks HD, Masterson KE, Genshaft SJ, Plotnik AN, Padia SA. Genicular artery embolization for treatment of symptomatic knee osteoarthritis: 2-year outcomes from a prospective IDE trial. J Vasc Interv Radiol 2024;35(12):1768-75. https://doi.org/ 10.1016/j.jvir.2024.08.028
13. Baerlocher MO, Nikolic B, Sze DY. Adverse event classification: clarification and validation of the Society of Interventional Radiology specialty-specific system. J Vasc Interv Radiol 2023;34(1):1-3. https://doi.org/10.1016/j.jvir.2022.10.011
14. Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman-Hill R. Chronic pain after total knee arthroplasty. EFORT Open Rev 2018;3(8):461-70. https://doi.org/10.1302/2058-5241.3.180004
15. Wylde V, Bertram W, Sanderson E, Noble S, Howells N, Peters TJ, et al. The STAR care pathway for patients with pain at 3 months after total knee replacement: a multicentre, pragmatic, randomised, controlled trial. Lancet Rheumatol 2022;4(3):e188-97. https://doi.org/10.1016/S2665-9913(21)00371-4
16. Chau Y, Roux C, Gonzalez JF, Breuil V, Bernard de Dompsure R, Fontas E, et al. Effectiveness of geniculate artery embolization for chronic pain after total knee replacement: a pilot study. J Vasc Interv Radiol 2023;34(10):1725-33. https://doi.org/10.1016/j.jvir.2023.06.026
17. Chau Y, Roux C, Breuil V, Trojani C, Gonzalez JF, Amoretti N, et al. Endovascular occlusion of neovascularization as a treatment for persistent pain after total knee arthroplasty. Cardiovasc Intervent Radiol 2020;43(5):787-90. https://doi.org/10.1007/s00270-020-02449-x.
18. Park CN, White PB, Meftah M, Ranawat AS, Ranawat CS. Diagnostic algorithm for residual pain after total knee arthroplasty. Orthopedics 2016;39(2):e246-52. https://doi.org/10.3928/01477447-20160119-06
19. McDowell M, Park A, Gerlinger TL. The painful total knee arthroplasty. Orthop Clin North Am 2016;47(2):317-26. https://doi.org/10.1016/j.ocl.2015.09.008
20. Paish HL, Baldock TE, Gillespie CS, Del Carpio Pons A, Mann DA, Deehan DJ, et al. Chronic, active inflammation in patients with failed total knee replacements undergoing revision surgery. J Orthop Res 2019;37(11):2316-24. https://doi.org/10.1002/jor.24398
21. Cornman-Homonoff J, Kishore SA, Waddell BS, Kesler J, Mandl LA, Westrich GH, et al. Genicular artery embolization for refractory hemarthrosis following total knee arthroplasty: technique, safety, efficacy, and patient- reported outcomes. J Vasc Interv Radiol 2021;32(8):1128-35. https://doi.org/10.1016/j.jvir.2021.04.020
22. Melian CM, Giannopoulos S, Tsouknidas I, Volteas P, Virvilis D, Koullias GJ. Geniculate artery endovascular embolization post-total knee arthroplasty for hemarthrosis treatment: a systematic review of the literature. J Endovasc Ther 2024;31(6):1158-64. https://doi.org/10.1177/15266028231157642
23. Autorino CM, Lauritto D, Escobar G, Alvarez Salinas E, San Román A, Santini Araujo E, et al. Hemartrosis recurrente en paciente con reemplazo total de rodilla. Revista Cirugía Reconstructiva de Cadera y Rodilla 2015;1(2): 122-9. Disponible en: https://acaro.org.ar/acarorevista/files/revistas/vol-1-nro-2/Vol-1-Nro-2-Agosto-2015.pdf
24. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008;1(3- 4):180-9. https://doi.org/10.1007/s12178-008-9031-6
25. Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow 2017;9(2):75-84. https://doi.org/10.1177/1758573216676786
26. Okuno Y, Iwamoto W, Matsumura N, Oguro S, Yasumoto T, Kaneko T, et al. Clinical outcomes of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. J Vasc Interv Radiol 2017;28(2):161-7.e1. https://doi.org/10.1016/j.jvir.2016.09.028
27. Okuno Y, Oguro S, Iwamoto W, Miyamoto T, Ikegami H, Matsumura N. Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study. J Shoulder Elbow Surg 2014;23(9):e199-206. https://doi.org/10.1016/j.jse.2013.12.014
28. Fernández Martínez AM, Baldi S, Alonso-Burgos A, López R, Vallejo-Pascual ME, Cuesta Marcos MT, et al. Mid-term results of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. Cardiovasc Intervent Radiol 2021;44(3):443-51. https://doi.org/10.1007/s00270-020-02682-4
29. Xu Y, Bonar F, Murrell GAC. Enhanced expression of neuronal proteins in idiopathic frozen shoulder. J Shoulder Elbow Surg 2012;21(10):1391-7. https://doi.org/10.1016/j.jse.2011.08.046
30. Hwang JH, Park SW, Kim KH, Lee SJ, Oh KS, Chung SW, et al. Early results of transcatheter arterial embolization for relief of chronic shoulder or elbow pain associated with tendinopathy refractory to conservative treatment. J Vasc Interv Radiol 2018;29(4):510-7. https://doi.org/10.1016/j.jvir.2017.11.013
31. Bagla S, Nagda S, Piechowiak R, Orlando J, Sajan A, Isaacson A. Results from a United States investigational device study of adhesive capsulitis embolization in the treatment of shoulder pain: the adhesive capsulitis embolization study. J Vasc Interv Radiol 2022;33(2):177-82. https://doi.org/10.1016/j.jvir.2021.10.031
32. Okuno Y, Yasumoto T, Koganemaru M, Suyama Y, Nishiofuku H, Horikawa M, et al. Transarterial embolization of neovascularity for refractory nighttime shoulder pain: a multicenter, open-label, feasibility trial. J Vasc Interv Radiol 2022;33(12):1468-75.e8. https://doi.org/10.1016/j.jvir.2022.08.016
33. Lopes PM, Cavalheiro F, Gonçalves R, Sousa F, Sousa P. Musculoskeletal embolization: endovascular treatment of adhesive capsulitis. ARP Rheumatol 2024;3(2):159-61. PMID: 38956999
34. Lanciego C, Puentes-Gutierrez A, Sánchez-Casado M, Cifuentes-Garcia I, Fernández-Tamayo A, Dominguez- Paillacho D, et al. Transarterial embolization for adhesive capsulitis of the shoulder: midterm outcomes on function and pain relief. J Vasc Interv Radiol 2024;35(4):550-7. https://doi.org/10.1016/j.jvir.2023.12.572