[Transarterial periarticular embolization as a treatment option for chronic joint pain].

CLINICAL ISSUE: Osteoarthritis-related chronic joint pain substantially impairs function and quality of life. A clinically relevant subgroup of patients remains insufficiently controlled by conservative care and is not yet eligible for, or declines, arthroplasty ("treatment gap").

STANDARD TREATMENT: First-line management includes weight reduction and physiotherapy, analgesics/nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular injections, and-when indicated-surgical options up to joint replacement.

TREATMENT INNOVATIONS: Transarterial periarticular embolization (TAPE) targets abnormal periarticular neovascularity/hypervascularity via superselective, blush-guided devascularization using temporary crystalline agents or resorbable/permanent microspheres.

DIAGNOSTIC WORK-UP: Accurate pain localization to the target joint and radiographic osteoarthritis (OA) grading are mandatory. Magnetic resonance imaging (MRI)/ultrasound may support selection by demonstrating inflammatory activity (synovitis/hypervascularity). Angiography identifies the pathological blush as the procedural endpoint.

EVIDENCE: Across studies, technical success is near 100% with clinically meaningful improvements (typically ~30-40 point pain reduction on a 0-100 visual analog scale) and gains in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)/Knee Injury and Osteoarthritis Outcome Score (KOOS); however, sham-controlled randomized controlled trials (RCTs) show mixed results. Adverse events are uncommon and mainly mild/self-limited; major complications are rare.

CONCLUSION

TAPE is a promising minimally invasive option, but its incremental benefit over placebo and optimal selection criteria require confirmation.

PRACTICAL RECOMMENDATIONS: Consider TAPE in specialized centers for refractory mild-to-moderate OA (strongest evidence for the knee; emerging data for hip/hand), using standardized protocols, particle sizes ≥ 100 µm when applicable, and strict nontarget prevention (e.g., skin cooling).