A Model of Lifelong Learning and Practice: Dr. Wu Ting-Kuo, Kaohsiung Medical University [Transarterial Microembolization (TAME)] [Academic Exchange] 2022-3-19

Author: Bow Wang, M.D.

Dr. Wu Dingguo, 72 years old and a retired distinguished professor, is the former director of the angiography laboratory at the Department of Imaging Medicine, Kaohsiung Medical University. He continues to diligently learn new knowledge.

When he learned that his junior colleague was performing transarterial embolization pain treatment, Dr. Wu, my mentor, was willing to travel from Kaohsiung to Tainan early in the morning to study and research together. He is truly a model of lifelong learning and practice.

Dr. Wu also observed a junior colleague complete Taiwan's first case of transarterial embolization (TAE) pain management for osteoarthritis of the foot and ankle last week, and shared his experience in treating peripheral arterial occlusive disease.

Ms. D, 65 years old, had been experiencing left ankle pain for over a year and a half, diagnosed with osteoarthritis. Despite rehabilitation and various injections, there was no significant improvement, requiring long-term pain medication to alleviate the pain, but she still felt uncomfortable and experienced joint tightness.

After blood tests, imaging, and ruling out other diseases by orthopedic surgeon Dr. Huang Ming-dong, rheumatologist Dr. Wu Jun-xin, and Bow Wang, M.D., and confirming no arterial stenosis in the foot, it was decided after discussion with Bow Wang, M.D. to undergo TAE pain management.

Bow Wang, M.D. uses a metal plate to mark the painful area on the patient's skin. Under arterial angiography, the corresponding location is visualized as a proliferating, fine, capillary-like blood vessel, which is then embolized and removed using medication.

After treatment, Ms. D's ankle pain and tightness improved.

However, Bow Wang, M.D. reminds patients that arterial embolization therapy for osteoarthritis has limitations. The main indications are a pain index exceeding 5 points and no significant improvement after more than three months of various treatments. Especially for joints like the ankle, it is necessary to first rule out peripheral arterial occlusive disease before considering this treatment.

This treatment is not suitable in the following situations:

1. Peripheral arterial occlusive disease

2. Severe tendon or ligament damage or rupture

3. Pain accompanied by other nerve compression symptoms, such as numbness

4. Poor renal function (eGFR < 30 mL/min/1.73m2)

5. Low platelet count, abnormal coagulation function

6. The patient is unable to lie flat for two hours

7. Pregnancy

Treatment side effects may include local hematoma and bruising at the puncture site; temporary local discoloration at the embolization site may occur, which will improve and disappear within minutes to a month.

It is recommended that patients undergo a detailed evaluation by a physician to confirm the true source of pain, and have a thorough discussion with their doctor and family to understand the treatment process and related precautions before receiving treatment for better assurance.