| 제목 |
Effect of Transcatheter Arterial Embolization for Knee Pain on Patients with Knee Osteoarthritis |
| 소속 |
Jeonbuk National University Medical School, Department of Physical Medicine & Rehabilitation1, Biomedical Research Institute of Jeonbuk National University Hospital, Research Institute of Clinical Medicine of Jeonbuk National University2, Jeonbuk National University Hospital, Translational Research & Clinical Trial Center for Medical Device3 |
| 저자 |
Dong-Ha Kang1,2, Da-Sol Kim 1,2, Yu-Hui Won1,2, Sung-Hee Park1,2, Myoung-Hwan Ko1,2, Jeong-Hwan Seo1,2, Gi-Wook Kim1,2*† |
Introduction
Transcatheter arterial embolization(TAME) is reported to relieve musculoskeletal pain through embolism in abnormal neovessels, but is not commonly performed.
Objective
We report the safety and efficacy of TAME based on the results observed after the intervention in three patients with knee osteoarthritis(OA). In addition, we compared differences in Power Doppler(PD) sonography before and after TAME.
Patients Concerns
Three patients who suffered from persistent knee pain for more than 1 year despite undergoing conservative treatment were included. They required surgical treatment but were either not suitable for it, or wanted additional conservative treatment. They had cognitive functions that could accurately express pain site and severity, and had no other musculoskeletal causes or radiating pain associated with knee pain besides knee OA.
Assessment and Outcome
We performed X-ray and PD sonography before and after TAME to confirm the vascularization around the knee joint. Pain and secondary deterioration measured using the Numeric Rating Scale(NRS) and Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) were evaluated before, immediately after, and 1 month after the intervention.
Intervention
TAME was performed by an experienced radiologist. Under local anesthesia, the common femoral artery access was gained using a 5F introducer sheath. A 4F angiographic catheter was introduced toward popliteal artery. Digital subtraction angiography was performed to depict the abnormal vascular staining of the genicular arteries around the knee. A 2F microcatheter was placed in the targeted arteries. An embolic agent (a suspension of imipenem/cilastatin sodium in contrast agent) was infused until the near stasis status of blood flow was attained(Figure 1). Patients 1 and 2 were treated with TAME on both knees at intervals of one week and three days, respectively, while it was performed only on the right knee for patient 3.
Result
The average values of NRS evaluated before and after the five TAMEs in three patients were 5.2 before, 3 immediately after, and 3.6 one month after TAME; the average values of WOMAC were 52, 38.4, and 36.4, respectively. The details of NRS and WOMAC for each patient are presented in Table 1. All patients had no significant changes in PD sonography after the intervention.
Patient 1 had a mild erythematous skin rash observed one day after TAME, and patients 2 and 3 complained of mild nausea and dizziness immediately after TAME. These manifestations were thought to be side effects of the contrast agent, and the they have improved after the administration of an antihistamine.
Conclusion
TAME, which involves the occlusion of abnormal neovessels within periarticular tissues of a painful knee, can be an effective treatment for reducing pain in patients who have not responded to other conservative treatments. We are preparing a prospective study of TAME in the patients with refractory musculoskeletal pain. |
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Figure A shows multifocal vascular staining lesions in the area of the descending genicular artery and the superior lateral genicular artery (arrows). Figure B shows the selective angiography of the descending genicular artery by microcatheter placement. An embolic agent was infused after the depiction of vascular staining lesions in selective angiography. Figure C shows the post-procedural angiography indicating markedly decreased vascular staining lesions around the popliteal artery.
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