Transarterial Embolization for the Treatment of Chronic Musculoskeletal Pain: A Systematic Review of Indications, Safety, and Efficacy

Kishore, SirishA; Sheira, Dina; Malin, Michaela L; Trost, David; Mandl, Lisa A.

doi:10.1002/acr2.11383

Cited by 21 publications

(5 citation statements)

References 52 publications

(58 reference statements)

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“…Common interventions for KOA include patient education, weight management, exercise therapy, physical therapy, pharmacologic therapy, and surgery therapy (15,16). Moreover, several innovative therapies for KOA, such as stem cell therapy (17), chondrocyte cell-sheet transplantation (18), injectable natural polymer hydrogels (19), geniculate artery embolization (20), and water-cooled radiofrequency ablation (21), have been proven effective by relevant studies. However, more rigorous clinical trials are needed to determine whether those treatments can be recommended in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

Feng

Wang

Jin

et al. 2023

Front. Public Health

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BackgroundManual therapy has been used as an alternative approach to treat knee osteoarthritis (KOA) for many years. Numerous systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its effectiveness and safety. Nevertheless, the conclusions of SRs/MAs are inconsistent, and the uneven quality needs to be critically appraised.ObjectivesTo conduct a comprehensive overview of the effectiveness and safety of manual therapy for KOA and the quality of relevant SRs/MAs, thus providing critical evidence and valuable direction for future researchers to promote the generation of advanced evidence.MethodsThe pre-defined search strategies were applied to eight electronic databases from inception to September 2022. Suitable SRs/MAs were included in accordance with the inclusion and exclusion criteria. The methodological quality, risk of bias, reporting quality, and evidence quality were assessed by two independent reviewers who used respectively the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Version (PRISMA 2020), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) based on the method of narrative synthesis. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the total effective rate.ResultsA total of eleven relevant SRs/MAs were included: nine SRs/MAs were rated critically low quality, and two were rated low quality by AMSTAR-2. According to ROBIS, all SRs/MAs were rated low risk in Phase 1 (assessing relevance) and Domain 1 (study eligibility criteria) of Phase 2. Three SRs/MAs (27.27%) were rated low risk in Domain 2 (identification and selection of studies). Ten SRs/MAs (90.91%) were rated low risk in Domain 3 (data collection and study appraisal). Five SRs/MAs (45.45%) were rated low risk in Domain 4 (synthesis and findings). And five SRs/MAs (45.45%) were rated low risk in Phase 3 (risk of bias in the review). By PRISMA 2020, there were some reporting deficiencies in the aspects of abstract (2/11, 18.18%), search strategy (0/11, 0%), preprocessing of merging data (0/11, 0%), heterogeneity exploration (6/11, 54.55%), sensitivity analysis (4/11, 36.36%), publication bias (5/11, 45.45%), evidence quality (3/11, 27.27%), the list of excluded references (3/11, 27.27%), protocol and registration (1/11, 9.09%), funding (1/11, 9.09%), conflict of interest (3/11, 27.27%), and approach to relevant information (0/11, 0%). In GRADE, the evidence quality was defined as moderate quality (8 items, 21.05%), low quality (16 items, 42.11%), and critically low quality (14 items, 36.84%). Among the downgraded factors, risk of bias, inconsistency, imprecision, and publication bias were the main factors. A re-meta-analysis revealed that manual therapy can increase the total effective rate in KOA patients (risk ratio = 1.15, 95% confidence interval [1.12, 1.18], p < 0.00001; I2 = 0, p = 0.84). There are four reviews that narratively report adverse effects, and no severe adverse reactions occurred in the manual therapy group.ConclusionsManual therapy may be clinically effective and safe for patients with KOA. However, this conclusion must be interpreted with caution because of the generally unsatisfactory study quality and inconsistent conclusions of the included SRs/MAs. Further rigorous and normative SRs/MAs are expected to be carried out to provide robust evidence for definitive conclusions.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022364672.

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Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

Feng

Wang

Jin

et al. 2023

Front. Public Health

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“…Secondary to this, an increase in the number of local pain receptors also contributes to bone structural damage and chronic pain [ 16 ]. A minimally invasive procedure used by interventional radiologists for bleed control or tumor vascularization block is fluoroscopically-guided transcatheter arterial embolization [ 17 ]. A new strategy was implemented for patients with symptomatic knee OA: the transarterial embolization (TAE) of genicular arteries with a brachial approach.…”

Section: Introductionmentioning

confidence: 99%

“…A new strategy was implemented for patients with symptomatic knee OA: the transarterial embolization (TAE) of genicular arteries with a brachial approach. By selective catheterization and embolization of specific arterial genicular branches, vascular supply is blocked, the release of pro-inflammatory mediators is decreased, and nociceptive triggering is diminished [ 17 ]. As an alternative to invasive procedures, the curative effect of the procedure is not yet proven [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

At the Edge of Orthopaedics: Initial Experience with Transarterial Periarticular Embolization for Knee Osteoarthritis in a Romanian Population

Russu

Bloj²,

Feier

et al. 2022

JCM

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Background: Transarterial embolization (TAE) of genicular artery branches is a relatively new technique that has emerged as a promising method for delaying invasive knee surgery in patients suffering from degenerative knee osteoarthritis (OA). In mild to moderate OA, invasive major surgery can be safely postponed, and patients with major risk factors now have an alternative. Our aim was to examine the impact of TAE on clinical outcomes in individuals with degenerative knee OA over a 12-month period. Methods: A case series of 17 patients diagnosed with knee OA and treated with TAE was included in the study. Every patient was clinically evaluated at different timeframes according to the Western Ontario and McMaster Universities’ arthritis index, knee injury, and osteoarthritis outcome scores, and the 36-item short-form survey (WOMAC, KOOS, and SF-36). Results: At the first follow-up (1 month), KOOS and WOMAC improved from 46.6 ± 13.2 (range 27.3–78.2) to 56.5 ± 13.9 (range 32.3–78.4; p = 0.023) and 49.5 ± 13.2 (range 29.3–82.3) to 59.8 ± 12.6 (range 39.3–83.5, p = 0.018), respectively. Physical SF-36 improved significantly from 42.1 ± 7.75 (range 30.3–57.3) to 50.5 ± 9.9 (range 35.6–67.9; p = 0.032). No significant changes in scores were observed at three, six, or twelve months after TAE. Conclusions: TAE provided early pain reduction and considerable improvement in quality of life without complications for a consecutive sample of Romanian patients with mild to severe knee OA.

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“…Recently, transarterial embolization (TAE) has emerged as a safe and effective minimally invasive treatment for chronic musculoskeletal pain. 13 , 14 , 15 , 16 Abnormal angiogenesis and accompanying pain-related nerves have been demonstrated as a possible source of persistent inflammation and pain in OA. 17 , 18 , 19 , 20 Thus, eliminating abnormal neovessels by intra-arterially infusing an embolic agent into the target vessels might relieve pain and restore the joint motion in patients with symptomatic OA.…”

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confidence: 99%

Short-term clinical outcomes of transarterial embolization for symptomatic hand osteoarthritis refractory to conservative treatment

Lee,

Lim,

et al. 2024

dir

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PURPOSE The present study aims to assess the short-term clinical outcomes and safety of transarterial embolization (TAE) for symptomatic hand osteoarthritis (OA) refractory to conservative treatment. METHODS The present retrospective cohort pilot study included nine patients who underwent TAE for symptomatic OA-associated hand pain in a single tertiary center between November 2022 and January 2023. The baseline and post-procedural OA-associated hand pain and function were assessed using the visual analog scale (VAS) and the Australian Canadian Hand Osteoarthritis Index (AUSCAN). The use of conservative treatment and pain medications was also recorded. Post-procedural adverse events were evaluated according to the Society of Interventional Radiology classification. RESULTS Compared with the baseline, the overall VAS scores were significantly decreased at 1-week, 1-month, 3-months, and 6-months after TAE (76 ± 15 mm versus 34 ± 18 mm, P < 0.001; 32 ± 11 mm, P < 0.001; 21 ± 15 mm, P < 0.001; 18 ± 19 mm, P = 0.002). Similarly, improvement in the mean total AUSCAN scores (22.0 ± 10.0 versus 13.2 ± 6.6, P = 0.007; 14.11 ± 7.3, P = 0.004; 9.8 ± 6.8, P = 0.004; 9.3 ± 7.4, P = 0.011) were documented. The use of other conservative treatment methods also gradually decreased. There were no severe adverse events reported during the follow-up period. CONCLUSION TAE is a feasible and safe treatment method for symptomatic hand OA refractory to conservative treatment. This minimally invasive procedure effectively relieves debilitating OA-associated joint pain and restores hand function with a durable treatment effect.

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Transarterial Embolization for the Treatment of Chronic Musculoskeletal Pain: A Systematic Review of Indications, Safety, and Efficacy

Cited by 21 publications

References 52 publications

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

At the Edge of Orthopaedics: Initial Experience with Transarterial Periarticular Embolization for Knee Osteoarthritis in a Romanian Population

Short-term clinical outcomes of transarterial embolization for symptomatic hand osteoarthritis refractory to conservative treatment

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