Skip to main content

Current Status of Trans-Arterial Embolization in Pain Management of Musculoskeletal Inflammatory Conditions — An Evidence-Based Review



To summarize the literature on trans-arterial embolization in inflammatory musculoskeletal conditions, focusing on efficacy and safety.

Materials and Methods

PRISMA guidelines were followed. A systematic literature search revealed 19 studies, with a total of 394 participants, eligible for inclusion.


The included studies consisted of case reports/series and non-randomized interventional studies, with knee osteoarthritis and adhesive capsulitis of the shoulder as the most frequent conditions. In all studies except one, pain was reduced up to four years after treatment. All adverse events were transient. Due to high heterogeneity, meta-analysis was not possible.


The included early studies showed encouraging results regarding efficacy and safety. However, randomized, placebo-controlled trials are warranted.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Clausen C, Dahl B, Frevert SC, Hansen LV, Nielsen MB, Lönn L. Preoperative embolization in surgical treatment of spinal metastases: single-blind, randomized controlled clinical trial of efficacy in decreasing intraoperative blood loss. J Vasc Interv Radiol. 2015;26:402–12.

    Article  Google Scholar 

  2. 2.

    Malling B, Lönn L, Jensen RJ, Lindh M, Frevert S, Brasso K, et al. Prostate Artery Embolization for Lower Urinary Tract Symptoms in Men Unfit for Surgery. Diagnostics. 2019;9:46.

    CAS  Article  Google Scholar 

  3. 3.

    Gupta JK, Sinha A, Lumsden MA, Hickey M. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Bonnet CS, Walsh DA. Osteoarthritis, angiogenesis and inflammation. Rheumatology. 2005.

    Article  PubMed  Google Scholar 

  5. 5.

    Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis. Nat Rev Rheumatol. 2012.

    Article  PubMed  Google Scholar 

  6. 6.

    Okuno Y, Matsumura N, Transcatheter OS. Arterial Embolization Using Imipenem/Cilastatin Sodium for Tendinopathy and Enthesopathy Refractory to Nonsurgical Management. J Vasc Interv Radiol. 2013.

    Article  PubMed  Google Scholar 

  7. 7.

    Casadaban LC, Mandell JC, Genicular EY. Genicular Artery Embolization for Osteoarthritis Related Knee Pain: A Systematic Review and Qualitative Analysis of Clinical Outcomes. Cardiovasc Intervent Radiol. 2021.

    Article  PubMed  Google Scholar 

  8. 8.

    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med Peer-Rev Indep Open-Access J. 2009;3:123–130.

    Google Scholar 

  9. 9.

    Covidence Systematic Review Software, Veritas Health Innovation, Melbourne, Australia. Available from:

  10. 10.

    Wewers ME, Lowe NKA. critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990.

    Article  PubMed  Google Scholar 

  11. 11.

    Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003.

    Article  PubMed  Google Scholar 

  12. 12.

    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003.

    Article  PubMed  Google Scholar 

  13. 13.

    McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods. 2021;12:55–61.

    Article  Google Scholar 

  14. 14.

    Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H. “Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document)”. Oxford Centre for Evidence-Based Medicine. Available from:

  15. 15.

    Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–58.

    Article  Google Scholar 

  16. 16.

    Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the brief pain inventory for chronic nonmalignant pain. J Pain. 2004.

    Article  PubMed  Google Scholar 

  17. 17.

    Iwamoto W, Okuno Y, Matsumura N, Kaneko T, Ikegami H. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up. J Shoulder Elbow Surg. 2017;26:1335–41.

    Article  Google Scholar 

  18. 18.

    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;28:995–1002.

    Article  Google Scholar 

  19. 19.

    Lee SH, Hwang JH, Kim DH, So YH, Park J, Cho SB, et al. Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis. Cardiovasc Intervent Radiol. 2019;42:1530–6.

    Article  Google Scholar 

  20. 20.

    Choi JW, Ro DH, Chae HD, Kim DH, Lee M, Hur S, et al. The Value of Preprocedural MR Imaging in Genicular Artery Embolization for Patients with Osteoarthritic Knee Pain. J Vasc Interv Radiol. 2020;31:2043–50.

    Article  Google Scholar 

  21. 21.

    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;31:1096–102.

    Article  Google Scholar 

  22. 22.

    Landers S, Hely R, Page R, Maister N, Hely A, Harrison B, et al. Genicular Artery Embolization to Improve Pain and Function in Early-Stage Knee Osteoarthritis-24-Month Pilot Study Results. J Vasc Interv Radiol. 2020;31:1453–8.

    Article  Google Scholar 

  23. 23.

    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;44:931–40.

    CAS  Article  Google Scholar 

  24. 24.

    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;44:443–51.

    Article  Google Scholar 

  25. 25.

    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;28:161–7.

    Article  Google Scholar 

  26. 26.

    Shibuya M, Yamamoto M, Okuno Y. Effect of Transcatheter Arterial Microembolization on Phantom Limb Pain Persisting for 17 Years. Cardiovasc Intervent Radiol. 2019;42:471–4.

    Article  Google Scholar 

  27. 27.

    Shibuya M, Sugihara E, Miyazaki K, Yamamoto M, Fujiwara K, Okuno Y. Effects of Transcatheter Arterial Microembolization on Persistent Trapezius Myalgia Refractory to Conservative Treatment. Cardiovasc Intervent Radiol. 2021;44:102–9.

    Article  Google Scholar 

  28. 28.

    Correa MP, Puton RC, Saleh JN, Noel RS, da Silva LHP, de Castro DM, et al. Short-term follow-up of embolization of hip synovitis. CVIR Endovasc. 2020;3:35.

    Article  Google Scholar 

  29. 29.

    Fernández-Martínez AM, Alonso-Burgos A, López R, Cuesta Marcos MT, Baldi S. Clinical Outcomes of Transcatheter Arterial Embolization for Secondary Stiff Shoulder. J Vasc Interv Radiol. 2021;32:489–96.

    Article  Google Scholar 

  30. 30.

    Katoh M, Schott P, Freyhardt P, Feyen L, Ziegler H-R, Kraft C. Transarterielle periartikuläre Embolisation (TAPE): klinischer Einsatz und erste Erfahrungen in Deutschland. RöFo - Fortschritte Auf Dem Geb Röntgenstrahlen Bildgeb Verfahr. 2020;192:1046–52.

    Article  Google Scholar 

  31. 31.

    Chau Y, Roux C, Breuil V, Trojani C, Gonzalez J-F, Amoretti N, et al. Endovascular Occlusion of Neovascularization as a Treatment for Persistent Pain After Total Knee Arthroplasty. Cardiovasc Intervent Radiol. 2020;43:787–90.

    Article  Google Scholar 

  32. 32.

    Kellgren JH, Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis. 1957;16:494–502.

    CAS  Article  Google Scholar 

  33. 33.

    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a Self-Administered Outcome Measure. J Orthop Sports Phys Ther. 1998;28:88–96.

    CAS  Article  Google Scholar 

  34. 34.

    Lauko K, Tangchaiburana S, Padia SA. Transarterial Genicular Artery Embolization as Treatment of Painful Knee Osteoarthritis in a 64-Year-Old Woman. J Radiol Nurs. 2020;39:89–91.

    Article  Google Scholar 

  35. 35.

    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;29:510–7.

    Article  Google Scholar 

  36. 36.

    Ciampi-Dopazo J, Puentes-Gutierrez A, Marquina-Valero M, Sanchez-Casado M, Lanciego-Pérez C. Combined transcatheter arterial embolization and rehabilitative treatment for adhesive capsulitis refractory to conservative treatment. Rev Interv. 2020;2:74–83.

    Google Scholar 

Download references


This study was not supported by any funding.

Author information




All authors contributed to the study conception and design. The literature search was developed and conducted by first author LH and reviewed and approved by all co-authors. Screening of eligible studies and data extraction were done independently by LH and MT. The first draft of the manuscript was written by LH with supervision by MT and LL. All authors reviewed, edited, and approved the final manuscript.

Corresponding author

Correspondence to Louise Hindsø.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 96 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hindsø, L., Riis, R.G.C., Hölmich, P. et al. Current Status of Trans-Arterial Embolization in Pain Management of Musculoskeletal Inflammatory Conditions — An Evidence-Based Review. Cardiovasc Intervent Radiol (2021).

Download citation


  • Interventional radiology
  • Inflammatory musculoskeletal disorders
  • Trans-arterial embolization
  • Pain management