Selective Arterial Embolization
Article Sidebar
Published:
Oct 27, 2025
Keywords:
Embolotherapy, selective arterial embolization, genicular artery embolization, osteoarthritis, knee osteoarthritis, painful total knee arthroplasty, adhesive capsulitis
Main Article Content
Abstract
Knee osteoarthritis is the most prevalent degenerative arthropathy and one of the leading causes of chronic pain and disability. Its pathophysiology involves chondral wear, synovial inflammation, pathological angiogenesis, and sensory neoinnervation. Treat- ment options range from conservative measures to arthroplasty; a subset of patients who are not yet surgical candidates would benefit from minimally invasive alternatives. Genicular artery embolization has emerged as a promising option by reducing neovascularization and, consequently, pain. Clinical improvements greater than 70% and a favorable safety profile have been reported. Its indications have also been extended to persistent pain after arthroplasty and to other chronic musculoskeletal entities (e.g., adhesive capsulitis), with encouraging results. Despite this promising early evidence, controlled trials and long-term follow-up are needed to define its role in the management of osteoarthritis and other musculoskeletal diseases and, in turn, to support its inclusion in treatment guidelines.
Downloads
Download data is not yet available.
Article Details
How to Cite
Bertoni, H. G., Bertoni, V., Autorino, C. M., & Manfrin, F. (2025). Selective Arterial Embolization. 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
Section
Review article
Copyright (c) 2025 Revista de la Asociación Argentina de Ortopedia y Traumatología
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.
References
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