Genicular artery embolisation

Genicular artery embolization (GAE) is a minimally invasive procedure primarily used to treat chronic knee pain, particularly from osteoarthritis (OA) that has not responded to conservative treatments. The procedure targets the blood vessels (genicular arteries) supplying the knee joint, reducing inflammation and pain by decreasing blood flow to the inflamed synovium.

Indications

GAE is indicated for patients who:

1. Suffer from Osteoarthritis: Particularly those with chronic knee pain due to osteoarthritis (Click here to read more on Osteoarthritis Of Knees, Shoulder)
2. Have Failed Conservative Treatments: Including medications, physical therapy, and intra-articular injections.
3. Are Not Ideal Candidates for Surgery: Patients who cannot undergo knee replacement surgery due to medical comorbidities or personal preference.

Procedure

1. Pre-procedure Evaluation:
   • Imaging: MRI or X-rays of the knee to assess the severity of osteoarthritis and inflammation.
   • Patient Assessment: Evaluation of overall health to ensure suitability for the procedure.
2. Catheter Insertion:
   • A small incision is made, typically in the groin or wrist, to access the femoral or radial artery.
   • Using fluoroscopic guidance, a catheter is navigated through the arterial system to the genicular arteries supplying the knee joint.
3. Angiography:
   • Contrast dye is injected through the catheter to visualize the blood vessels and identify the target genicular arteries contributing to knee pain.
4. Embolic Agent Injection:
   • Tiny embolic particles are injected into the target genicular arteries to block blood flow.
   • The reduction in blood flow decreases inflammation and reduces pain by limiting the supply of inflammatory mediators to the knee joint.
5. Post-embolization Imaging:
   • Follow-up angiography is performed to confirm the successful embolization of the target vessels.

Benefits

• Pain Relief: Significant reduction in knee pain, improving patient quality of life.
• Minimally Invasive: Less risk and shorter recovery time compared to surgical options.
• Reduced Inflammation: Decreased blood flow to the inflamed synovium reduces inflammation and its associated symptoms.

Risks and Considerations

• Procedure-related Complications: Possible risks include infection, allergic reaction to contrast dye, vessel perforation, or non-target embolization.
• Post-embolization Syndrome: Temporary pain, swelling, or discomfort in the knee may occur after the procedure.
• Limited Long-term Data: While short-term results are promising, long-term efficacy and outcomes are still being studied.
• Not a Cure: GAE alleviates symptoms but does not cure the underlying osteoarthritis.

Conclusion

Genicular artery embolization is a promising treatment option for patients with chronic knee pain due to osteoarthritis, offering a minimally invasive alternative for those who have not responded to traditional therapies. By targeting the blood supply to the inflamed synovium, GAE can significantly reduce pain and improve function, enhancing the patient’s quality of life.