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

Abstract

Purpose: To evaluate the feasibility, safety, and efficacy 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 ± 9.97 years) with painful chronic AT, not responding to conservative management for ≥3 months. Superselective cannulation of branches from the posterior tibial artery or the peroneal artery supplying the point of maximal pain in the Achilles tendon was performed. Branches showing hypervascular staining were embolized using a suspension of 500mg of imipenem/ cilastatin sodium in 5mL of iodinated contrast agent. Visual analogue 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 post-procedure.

Results: Hypervascular staining at the point of maximal pain was seen in all patients. Branches from the posterior tibial artery or the peroneal artery supplying the area of hypervascular staining could be superselectively embolized in 18/20 limbs, indicating 90% technical success. Significant decrease in VAS score (Median (IQR): 7(7-8) vs. 1(1-2); p<0.0001) and significant increase in VISA-A score (Median (IQR): 29.5(24-33) vs. 68(56-76); p=0.0001) were noted on day 1 post-procedure which persisted through one 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.