By Russell Becker, DO
For years, patients with chronic knee osteoarthritis or a stubborn frozen shoulder have faced a narrow set of choices: manage the pain with medication and physical therapy, accept a series of injections that eventually stop working, or move toward surgery. At Vascular Center of Naples, our interventional vascular surgeon team offers a minimally invasive alternative that is changing that conversation, arterial embolization.
What Is Embolization?
Embolization is an image-guided procedure in which a physician threads a thin catheter through the blood vessels, usually entering through a small puncture in the groin or wrist, and guides it to the specific arteries feeding an inflamed joint. Tiny particles, smaller than a grain of sand, are then released to reduce blood flow to abnormal, newly formed vessels that develop around arthritic or chronically inflamed tissue.
This buildup of fragile new blood vessels, a process called neovascularization, is now understood to be a major driver of the pain and swelling associated with osteoarthritis and conditions like frozen shoulder. These vessels carry nerve fibers along with them, and they feed ongoing inflammation in the joint lining. By reducing blood flow specifically to these abnormal vessels, embolization can calm inflammation and reduce pain signaling, while leaving normal circulation to the rest of the joint intact.
Genicular Artery Embolization for Knee
Osteoarthritis
The most established use of this technique is genicular artery embolization (GAE) for knee osteoarthritis. The procedure typically takes one to two hours and is performed under conscious sedation, allowing most patients to go home the same day. Using X-ray guidance and contrast dye, the interventional vascular surgeon identifies the genicular arteries supplying the knee and delivers embolic particles to the specific areas of inflammation the patient identifies as painful.
GAE is generally considered for patients with mild to moderate knee osteoarthritis who have not gotten lasting relief from physical therapy, anti-inflammatory medication, or steroid injections, but who are not yet ready for, or are not good candidates for total knee replacement. It is intended to fill the treatment gap between conservative care and major surgery. Clinical studies, including prospective trials and long-term follow-up data, have reported meaningful reductions in pain and improved function for many patients, with some research showing benefits persisting at two years. Results tend to be more durable in patients with earlier-stage arthritis, and while outcomes vary, published data suggest a substantial majority of appropriately selected patients experience significant improvement.
As with any medical procedure, GAE is not guaranteed to work for everyone, and researchers continue to study exactly how much of the benefit comes from the embolization itself versus other factors, some randomized, placebo-controlled trials have shown mixed results, underscoring the importance of an honest, individualized conversation with your physician about expectations.
Embolization for Frozen Shoulder
Frozen shoulder, or adhesive capsulitis, causes progressive stiffness and pain that can make even simple movements like reaching overhead or behind the back difficult for months or years. Research groups studying the condition have found that, like the arthritic knee, the frozen shoulder capsule often develops excess abnormal blood vessels associated with pain and inflammation.
Building on the same principles used in GAE, interventional vascular surgeons are now investigating and, in select cases, offering transarterial embolization targeting the small arteries around the shoulder capsule. Early studies and case series suggest the approach may reduce pain and improve range of motion for patients who have not responded adequately to physical therapy, steroid injections, or hydrodilation. Because this application is newer than knee embolization, it is typically reserved for patients who have exhausted standard conservative treatments, and candidacy is determined case by case.
Is Embolization Right for You?
Embolization is not a replacement for physical therapy, weight management, or other foundational treatments for joint pain — it is best thought of as an additional tool, particularly for patients caught in the gap between conservative care and surgery. Recovery is typically quick, with most patients resuming normal activities within a few days, and the risk of major complications is low compared to surgical alternatives.
At Vascular Center of Naples, our interventional vascular surgeon evaluates each patient individually, reviewing imaging, treatment history, and overall health to determine whether embolization is an appropriate option. If you have been living with persistent knee osteoarthritis pain or a frozen shoulder that hasn’t responded to conservative treatment, we encourage you to schedule a consultation to discuss whether this minimally invasive approach could be right for you.
It’s no stretch to say that Russell Becker, DO, a fellow-trained vascular surgeon practicing at Vascular Center of Naples in Naples, Florida, gets into things for the long run. Dr. Becker, who runs marathons in his free time, has experience and interest in all areas of vascular and endovascular surgery, including treatment of conditions like carotid artery disease, hemodialysis access creation and maintenance, and diseases of the veins.
1875 Veterans Park Dr. Suite 2203
Naples, FL 34109
239-431-5884
www.VascularCenterNaples.com