Musculoskeletal Embolization Innovation: Keys to Highlighting Neovessels and Advanced Perspectives

Excerpt

Musculoskeletal (MSK) embolization represents a promising advancement in the treatment of chronic osteo-articular pain [1]. However, many questions remain unanswered such as the selection of adequate patients for treatment and standardization of the procedure. In this perspective, emphasis is often placed on the necessity to locate neovessels defined by a pseudo-tumoral “blush.” The embolization of these targets is the endpoint of the procedure and is commonly described as a direct marker of the technical success of this treatment [2]. Therefore, detecting neovessels is a key step in performing embolization. This term refers to the pathophysiology of chronic inflammatory pain, which involves the development of pathological neovascularization, indicating significant inflammatory activity in the target region [3]. The degree of displaying neovessels on the angiogram before embolization depends on the angiographic technique and varies from one team to another. It is important to know whether this variability is linked to the patient himself or to a failure to detect neovessels during angiography. With this in mind, the method for identifying neovessels must be mastered to avoid inappropriate patient management. Our approach has been enriched through the use of a dedicated animal model [4]. Through the percutaneous induction of patellar tendinopathy in pigs, this model has allowed us to deepen our understanding to uncover neovessels. It appears that these neovessels can exhibit resistive flow, related to the small size of the capillary and their mesh resembling a fishing net. The distance from the vascular lumen at the injection site is also a significant factor to consider. …