Hemophilic Chronic Synovitis: Therapy of Hemarthrosis using Endovascular Embolization of Knee and Elbow Arteries

Abstract

Congenital hemophilia is a hereditary bleeding disorder that affects 1 in 5,000 males and is characterized by repetitive musculoskeletal bleeding episodes. Selective embolization of the knee and elbow arteries can prevent bleeding episodes. To evaluate the long-term efficacy of these procedures, we assessed the outcomes of 30 procedures performed in our center. We performed 30 procedures in 27 hemophilic patients, including 23 knee, and 7 elbow procedures. To evaluate the efficacy of selective embolization of knee and elbow arteries in people with hemophilia, we analyzed the number of bleeding episodes during 12months before the procedure compared with the amount of episodes that occurred 3, 6, and 12months after embolization. Twenty-nine of 30 procedures were classified as successful. The median of 1.25 episodes per month (range 0-3) observed before the procedure was reduced to 0 (range 0-1.67; p<0.001) at 3months, 0.17 (range 0-1.67; p<0.001) at 6months, and 0.33 (range 0-1.67; p=0.024) at 12months. Three patients remained free of bleeding events for more than 6months. Additionally, after the procedure there was a significant reduction in factor FVIII usage that sustained up to 12months after the procedures. No serious adverse events were observed. Selective angiographic embolization of knee and elbow arteries is a feasible procedure that can prevent repetitive bleedings, which would translate in better joint outcomes for these patients.