Hand Arthritis Embolization Risks and Side Effects

Quick Answer

No major complications have been reported in the five published hand embolization studies, which total 204 patients. Minor side effects such as a temporary pale hand and artery spasm are detailed in only one 9-patient study, and the studies are too small to rule out rare serious problems.

Any procedure that slows blood flow in the hand deserves hard questions about risk. This article sets out what the published studies reported, what they left out, and which concerns are still theoretical. Dr. Fox evaluates patients for hand and finger embolization at our Manhattan office, and this article is meant to help you prepare for that conversation. For how the treatment works, see our hand arthritis embolization page.

The short version

Across five published studies and 204 patients, no major or severe complication has been reported.
Minor side effects were described in detail in only one study, of 9 patients. In that study a temporary pale hand occurred in every patient and temporary artery spasm in 4.
Four of the five studies, covering 195 of the 204 patients, do not give minor-event rates in their published summaries.
All five studies are small and uncontrolled. Two hundred patients is far too few to rule out a rare serious problem, such as lost blood flow to a finger.
The embolic used in nearly all published cases is an antibiotic used off-label.

What the studies reported

Study (all uncontrolled case series)	What it says about adverse events
Inui 2021, 31 patients, thumb base	"No major adverse events were encountered." Minor events not given in the summary
Liang 2023, 58 patients, finger joints	"No severe or life-threatening adverse events were encountered." Minor events not given in the summary
Kubo 2023, 92 patients, finger joints	"No major adverse events were observed." Minor events not given in the summary
Lee 2024, 9 patients, mixed hand arthritis	Temporary pale skin of the treated hand in all 9. Temporary radial artery spasm in 4. No tissue death, tendon rupture, muscle weakness, numbness or tingling
Konduru 2026, 14 patients, thumb base (US)	"No major adverse outcomes reported." Minor events not given in the summary

The pale hand in the Lee study looked normal again about 30 minutes after the infusion. The artery spasm passed without lasting effects.

What is not reported

This is the most important gap. For 195 of the 204 published patients, every study except the 9-patient pilot, the available summaries state only that nothing major happened. They do not say how many people had a pale or blotchy hand, pain during the injection, bruising at the wrist, soreness afterward or temporary numbness.

So the detailed picture of minor side effects comes from 9 patients in one hospital. Also missing from everything published: results beyond 24 months, radiation dose for hand procedures, and any data in people with Raynaud's, scleroderma, rheumatoid arthritis or previous hand surgery.

A 2026 independent review of embolization for joint pain described the safety of each joint's blood supply as "not fully defined" for the newer sites, which include the finger joints and thumb base. Our summary of what the hand embolization studies show covers the evidence limits in more depth.

Why a temporary, dissolving agent is used in the fingers

Fingers are supplied by small arteries with little room for error. The four studies that name their agent all used imipenem/cilastatin, a short-acting agent. The one US study does not name its agent in its summary.

Imipenem/cilastatin is an antibiotic. It is only slightly soluble in water, so when mixed with contrast dye it forms tiny crystals that briefly slow flow in small vessels. In a laboratory study the particles averaged about 29 micrometers across and dissolved completely in about 92 minutes. In an animal study, all 11 arteries treated with it had largely or fully reopened at 48 hours, compared with none of 4 arteries treated with non-dissolving microspheres.

The authors of the Lee study said they chose it for its transient effect and its safety profile. The idea is that blood flow to abnormal vessels around the joint is interrupted for a short time and then returns.

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This article is part of our Embolization Guide.

The concern about blood flow to a finger

The risk doctors think about most is embolic material reaching healthy tissue and reducing its blood supply. The Lee authors named this directly as "ischemia and non-target embolization." In a finger, the feared outcome would be skin or tissue damage from lost circulation.

Here is where things stand:

No case of finger ischemia, tissue death or lasting numbness has been reported in the hand arthritis studies.
That is reassuring, but the studies are small and uncontrolled, so a rare event cannot be excluded.
The Lee authors suggested pressing on or banding fingers that are not being treated to limit how much embolic reaches them. They described this as unproven and needing more study.
A French safety trial (NCT06611007) lists Raynaud's syndrome, scleroderma, narrowed arm arteries and a previous radial artery clot or tear among its exclusion criteria. These are exclusion criteria from a trial registration, not proven contraindications. No study has reported what happens in such patients.

Whether your circulation history changes the picture is part of the candidacy discussion in am I a candidate for hand arthritis embolization.

Skin changes and soreness in related studies

Two studies outside hand arthritis add context. They are not hand arthritis data and should not be read that way.

A 2026 Korean study of embolization for chronic wrist pain (12 procedures in 11 patients, using a different embolic) found temporary net-like skin redness after 7 of 12 procedures. It cleared without treatment within a week.
A 2025 report on 431 patients treated for other musculoskeletal conditions found increased pain at the treated site lasting more than 7 days in 7.1% of those who received imipenem/cilastatin. No severe adverse events were reported.

Puncture-site issues

In three of the Asian hand studies a 24-gauge needle or cannula, which is thin, was placed in a wrist artery; the fourth describes wrist artery access without further detail. In the Lee study the site was pressed by hand and covered with a band-aid. Bruising and bleeding rates at the wrist are not reported in the hand studies.

Any artery puncture can injure the vessel. In the Korean wrist-pain study, which was catheter-based, one patient developed a pseudoaneurysm (a contained leak) at a groin puncture site and one had a tear in the lining of an upper-arm artery. Both resolved. The one US hand series used a microcatheter in the radial artery, so ask which access method is planned for you. What the procedure involves is described in is hand arthritis embolization painful.

Allergy, contrast dye and kidney questions

Antibiotic allergy. Imipenem/cilastatin belongs to the beta-lactam family of antibiotics. Its FDA label lists hypersensitivity to any component as a contraindication and warns that serious allergic reactions can occur with beta-lactams. The Lee study excluded anyone with an antibiotic allergy. If you have ever reacted to an antibiotic, say so early.

Contrast dye. The Lee study mixed the embolic with iodinated contrast and excluded people allergic to it. The French trial also excludes contrast allergy.

Kidneys. The French trial excludes people with severe kidney disease, dialysis or a kidney transplant. Again, that is a trial exclusion criterion. The hand studies do not report any kidney problems.

Off-label status

No embolic agent has been approved or cleared by the FDA specifically for hand or finger arthritis. Imipenem/cilastatin is approved as an intravenous antibiotic for serious bacterial infections, and its label does not mention embolization or injection into an artery. Using it as an embolic is off-label use. A 2026 expert consensus on knee embolization notes that the other embolic agents used for knee embolization in the United States also remain off-label pending regulatory approval.

You should be told when a treatment involves off-label use. Which embolic agents US practices use in the hand is not documented in the published literature, so ask what would be used in your case and why. Because the treatment is investigational, insurers are likely to review it that way. See is hand arthritis embolization covered by insurance.

When to call the doctor or seek urgent care

The published studies do not provide a list of warning signs. The guidance below follows from the concerns the researchers themselves raised, and the instructions you receive from the treating doctor take priority.

Call the office the same day if:

A finger or part of the hand is still pale, blue, mottled or cold after you have gone home. In the one study that tracked it, color returned in about 30 minutes.
You have new numbness, tingling or weakness in the hand.
The wrist puncture site bleeds through its dressing, swells or develops a growing lump.
Pain in the hand is much worse than before the procedure and is not settling.

Call 911 or go to an emergency room if:

You have signs of a serious allergic reaction, such as trouble breathing, swelling of the face or throat, or widespread hives.
Bleeding at the wrist does not stop with firm pressure.
A finger turns white or dark and severely painful and you cannot reach the office.

For how risks compare across other joints, see our embolization guide.

Frequently Asked Questions

Has anyone lost blood flow to a finger after hand embolization?

No case of finger ischemia, tissue death or lasting numbness is reported in the five published hand arthritis studies, which total 204 patients. The studies are small and uncontrolled, so a rare event cannot be ruled out.

Why did patients' hands turn pale?

In a 2024 study of 9 patients, every treated hand turned pale for a short time, and color returned in about 30 minutes. The paper does not explain the cause. The other studies do not report how often this occurred.

Is the embolic agent approved for hand arthritis?

No. The agent used in nearly all published hand studies, imipenem/cilastatin, is an antibiotic whose FDA label does not include embolization, so this is off-label use. No embolic agent is approved or cleared specifically for hand or finger arthritis.

Can I have it if I am allergic to antibiotics?

Imipenem/cilastatin is a beta-lactam antibiotic, its label lists hypersensitivity as a contraindication, and one hand study excluded people with antibiotic allergy. Tell the doctor about any antibiotic reaction before going further.

What side effects were most common?

Only one study of 9 patients reports minor events: a temporary pale hand in all 9 and temporary artery spasm in 4. Rates for the other 195 published patients are not available from the study summaries.

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Sources

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with joint or tendon pain that hasn’t improved? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether embolization is right for you. Call (212) 362-3470 or request an appointment online.

Hand Arthritis Embolization: Risks and Side Effects