Transarterial Embolization Using Imipenem/Cilastatin for Chronic Painful Achilles Tendinopathy Refractory to Conservative Management.

PURPOSE: To evaluate the feasibility, safety, and effectiveness of transarterial embolization (TAE) for painful chronic Achilles tendinopathy (AT) refractory to conservative management.

MATERIALS AND

METHODS

This prospective study included 20 limbs in 18 patients (7 males; mean age, 45.89 years [SD ± 9.97]) with painful chronic AT, not responding to conservative management for ≥3 months. Superselective cannulation of branches from the posterior tibial artery (PTA) or the peroneal artery (PA) supplying the point of maximal pain in the Achilles tendon was performed. Branches showing hypervascular staining were embolized using a suspension of 500 mg of imipenem/cilastatin sodium in 5 mL of iodinated contrast agent. Visual analog scale (VAS) and Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A) scores were used to assess pain and function at baseline, 1 day, 1 week, 1 month, 3 months, 6 months, 9 months, and 12 months after the procedure.

RESULTS

Hypervascular staining at the point of maximal pain was seen in all patients. Branches from the PTA or the PA supplying the area of hypervascular staining could be superselectively embolized in 18 of 20 limbs, indicating 90% technical success. Significant decrease in VAS score (median [interquartile range {IQR}], 7 [7-8] vs 1 [1-2]; P < .0001) and significant increase in VISA-A score (median [IQR], 29.5 [24-33] vs 68 [56-76]; P = .0001) were noted on Day 1 after the procedure, which persisted through 1 year of follow-up. Clinical success, defined as a >50% reduction in VAS score, was achieved in 94.44% (17/18) of procedures.

CONCLUSIONS

TAE is a feasible, safe, and effective treatment for alleviating pain associated with chronic AT refractory to conservative management, with a low risk of adverse events.