Ankle embolization is performed on an outpatient basis under local anaesthesia. It targets the inflammatory neovessels of the ankle synovium, responsible for chronic pain, without incision or prolonged immobilisation.
What are the expected benefits?
- Reduction of chronic ankle pain in 70 to 80% of cases at 6 months
- Outpatient treatment under local anaesthesia, without hospital admission
- No immobilisation needed, unlike arthroscopy/synovectomy
- Preserves the normal blood supply of cartilage, ligaments and bone structures
- Repeatable technique in case of partial response
- Not contraindicated in the presence of a prosthesis or osteosynthesis hardware
Indications for ankle embolization
Ankle artery embolization is offered to patients with chronic ankle pain (≥ 3 months) that has failed conservative treatments (analgesics, NSAIDs, corticosteroid injections, physiotherapy), in the following situations:
- Tibiotalar osteoarthritis (ankle osteoarthritis) symptomatic with inflammatory synovitis visible on MRI
- Chronic ankle synovitis resistant to injections
- Rheumatoid arthritis or inflammatory arthropathy localised to the ankle, in addition to disease-modifying treatment
- Residual pain after surgery or severe sprain related to persistent pathological synovial neovascularisation
- Patients who are inoperable or decline ankle fusion or replacement
Mechanism: the synovial neovessels of the ankle
In the chronically painful ankle, the synovium develops pathological neoangiogenesis: new abnormal microvessels accompanied by nociceptive nerve fibres colonise the synovial membrane and the areas of periarticular enthesopathy. This neurovascular co-growth (a process known as neoinnervation) amplifies and perpetuates pain signals.
Embolization targets these pathological neovessels selectively, preserving the normal blood supply of the adjacent cartilage, ligaments and bone structures.
The targeted ankle arteries
Ankle embolization acts on the arterial network feeding the pathological synovium:
- Anterior tibial artery and its anterior tibiotalar branches
- Posterior tibial artery and its malleolar and calcaneal branches
- Peroneal artery and its lateral malleolar branches
Hyperselective catheterisation makes it possible to reach the 1 to 2 mm arterial branches that specifically supply the inflammatory synovial areas, under real-time angiographic guidance.
Several series published in the Journal of Vascular and Interventional Radiology (JVIR) and European Radiology report response rates of 70 to 80% for ankle pain at 6 months after embolization of the synovial neovessels, with good tolerance and a favourable safety profile.
Ankle MRI to document the synovitis and neovascularisation. Blood tests. Discussion of the indication. Pain questionnaire VAS + FAAM (Foot and Ankle Ability Measure).
Puncture of the femoral or radial artery. Arteriography of the ankle arteries. Hyperselective catheterisation of the pathological synovial branches. Injection of calibrated microspheres (75-150 µm). Duration: 45 to 90 minutes.
Monitoring for 2 to 4 hours. Discharge the same day. Mild local pain possible for 24-48h, treated with simple analgesics. No immobilisation required.
Clinical pain assessment (VAS, FAAM). Control MRI if needed. Response rate of 70-80% at 6 months in published series.
| Criterion | Ankle embolization | Corticosteroid injection | Arthroscopic synovectomy |
|---|---|---|---|
| Anaesthesia | Local | Local | General or spinal |
| Hospital stay | Outpatient | Outpatient visit | 1-2 days |
| Immobilisation | None | None | 2-4 weeks |
| Efficacy at 6 months | 70-80 % | 40-60% (temporary) | 60-75 % |
| Repeatable | Yes | Yes (limited) | No |
| Contraindicated in case of infection | No | Yes | Yes |
What are the possible after-effects and complications?
The complications are as follows:
| Complication | Description | Frequency |
|---|---|---|
| Haematoma at the puncture site | Spontaneous resolution | < 3 % |
| Transient pain | 24 to 48h, simple analgesics | Common |
| No improvement | Discussion of alternatives | 20–30 % |
What other techniques and alternatives are possible?
💉 Corticosteroid injections
First-line treatment, with an effect that is often transient and limited over time.
🔨 Physiotherapy
Essential as first-line treatment, to be continued alongside embolization.
🏥 Arthroscopy / synovectomy
Surgical removal of the inflammatory synovium, more invasive, reserved for failure of conservative treatments.
🦴 Fusion / replacement
Surgical solutions of last resort for advanced arthropathy.
What are the limits of the treatment?
Pain improvement is progressive over 4 to 12 weeks. In 20 to 30% of cases, improvement is insufficient and a repeat embolization, an injection or surgery may be discussed. In all cases, arthroscopy/synovectomy or ankle fusion/replacement remain possible.
What if I decide not to have the treatment?
You remain entirely free in your decision. Your doctor will discuss the alternatives with you: injections, physiotherapy, arthroscopy/synovectomy, or ankle fusion/replacement depending on your situation.
Frequently asked questions
Is ankle embolization effective for osteoarthritis?
Can I walk after ankle embolization?
Can embolization replace ankle fusion?
Is there a risk of bone necrosis after ankle embolization?
Is embolization effective in rheumatoid arthritis?
Knee, ankle, wrist, shoulder, epicondyle: complete guide to joint embolization à Cochin AP-HP.