CRPS Embolization

Background and indications

Algodystrophy, or Complex Regional Pain Syndrome (CRPS), is a chronic pain condition that typically develops after trauma, surgery, or fracture. It manifests with disproportionate pain, edema, skin changes (temperature, color, sweating), joint stiffness, and sometimes bone demineralization. CRPS type I (without identifiable nerve injury) is the most common form.

Neovessel embolization is offered as a complementary treatment for forms refractory to conventional treatments (physiotherapy, analgesics, sympathetic blocks, bisphosphonates). The rationale is based on pathological neovascularization and neurogenic inflammation observed in CRPS.

Pre-procedure assessment

Assessment includes confirmation of clinical diagnosis according to Budapest criteria, MRI showing inflammatory signs (bone marrow edema, synovitis, soft tissue thickening), and triple-phase bone scintigraphy. Pain assessment (VAS, DN4 questionnaire) and treatment history are documented.

Procedure

Under local anesthesia, a microcatheter is introduced through an artery. Under fluoroscopic guidance, arteries of the affected region are explored and areas of pathological neovascularization (abnormal blush) are identified and embolized in a super-selective manner with small microspheres (75 µm). The procedure specifically targets abnormal neovessels without compromising normal vasculature. Duration is approximately 60 to 90 minutes.

Results and scientific evidence

Initial results published by Okuno et al. on CRPS patients showed significant pain and functional improvement after neovessel embolization, with VAS score reduction of more than 50% in most responders (Okuno et al., CardioVascular and Interventional Radiology, 2019). Data remain preliminary and controlled studies are ongoing.

This technique is considered experimental and offered as part of a multidisciplinary pain management approach, complementing established treatments.

Risks and complications

Complications are similar to other joint embolizations: transient skin discoloration (5-10%), local pain (< 5%). Skin necrosis risk is minimal with super-selective catheterization and small microspheres.

Recovery

Return to activities is possible the following day. Physiotherapy and functional rehabilitation are essential as complement. Improvement is progressive over 2 to 8 weeks. Follow-up at 1, 3, and 6 months.

Practical information

The procedure is performed as an outpatient or short inpatient stay depending on the case. It is performed by a specialized interventional radiologist, as part of a multidisciplinary pain management approach.