A precision approach: selective genicular artery embolization for knee pain in chronic tophaceous gout
Year: 2025
Type: article
Study design: Case Report
Abstract: A 67-year-old man with longstanding, undertreated chronic tophaceous gout presented with right knee pain, significantly impairing his quality of life. Examination revealed no signs of acute arthritis or effusion. Dual-energy computed tomography (DECT) of the right knee revealed extensive structural damage and tophaceous deposits (Fig. 1A), with axial images (Fig. 1B) showing synovial hypertrophy and tophi in the patellofemoral compartment. MRI identified hyperintense synovial tissue and soft tissue oedema corresponding to the site of maximum pain (Fig. 1C). Given the polyarticular involvement and the severe bilateral impairment of knees and ankles, the patient was deemed a suboptimal candidate for knee arthroplasty. Transarterial embolization was proposed and accepted [1]. Angiography confirmed synovial arterial hypervascularity in the medial compartment (Fig. 1D). Resorbable gelatine microspheres 100–300 μm (Nexsphere-F, NextBioMedical) were selectively injected into the descending genicular artery supplying the target tissue, achieving resolution of the distal hypervascularity (Fig. 1E). One month after the procedure, MRI showed improvement of the oedema (Fig. 1F). The patient reported significant reduction of pain in the right knee, improving from 9 to 2 cm on a 0–10 cm visual analog scale, and a decrease in WOMAC from 43 to 30 on a 0–96 scale [2], mainly sustained by residual stiffness and disability.
Source: Lara D. Veeken
Institutions: Istituto Ortopedico Rizzoli, University of Bologna
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4408567141