Transarterial embolization in musculoskeletal care: an indication-stratified narrative review

Abstract Background Transarterial embolization (TAE) is increasingly used across a broad spectrum of musculoskeletal conditions, ranging from established hemostatic and tumor-related indications to emerging pain-directed procedures for degenerative joint disease and chronic inflammatory tendinopathies. Because these applications differ substantially in clinical maturity, methodological quality, durability of outcomes, and comparative evidence, an indication-stratified synthesis is needed. Main body This narrative review summarizes technical principles, vascular anatomy considerations, embolic agent selection, clinical indications, and evidence maturity in musculoskeletal TAE. Hemostatic and selected tumor-related applications are established components of multidisciplinary care, whereas pain-directed embolization, including Genicular artery embolization for knee osteoarthritis and embolization for tendinopathies, is generally performed as a stand-alone minimally invasive procedure targeting pathological neovascularity. Current evidence remains heterogeneous, with variable study designs, follow-up, endpoints, and definitions of technical and clinical success. Conclusions Musculoskeletal TAE is an expanding field with established, intermediate, and exploratory indications. Its evidence base is strongest for hemostatic and selected tumor-related applications, whereas stand-alone pain-directed embolization requires careful patient selection, standardized outcome assessment, and further comparative trials to define durability and clinical value.