Background: Some reports have suggested that arterial embolization (AE) is a good
indication to manage recurrent spontaneous hemartroses (RSH) that are refractory to intensive
prophylaxis (RIP) in people with hemophilia (PWH).
Objective: To clarify the role of AE in RSH that are RIP in PWH.
Method: A literature review of arterial embolization in patients with hemophilia was performed
using MEDLINE (PubMed) and the Cochrane Library.
Results: A total of 68 articles were found, of which 6 were selected and reviewed because they were
deeply focused on the topic. The total number of AEs performed so far is 78 in 69 patients. Four
second AEs were required (4/78), and a third AE in one (1/78). Two complications have been found
so far: a pseudoaneurym (1/78) of the femoral artery at the puncture site (that eventually required
surgical repair) and a patient (1/78) that had recurrence of bleeding for whom surgical exploration
was required. AE seems to be a good procedure for RSH that are RIP.
Conclusion: AE seems to be too aggressive to be considered the first resort. Radiosynovectomy
(RS) must always be the first resort. AE should only be indicated in RSH that are RIP to 3 RSs (with
6 month intervals) followed by an arthroscopic synovectomy. AE in PWH is technically challenging
and should be performed by highly skilled interventional radiologists.