Last updated: 2025-10-28
Osteoarthritis (OA) is a degenerative joint disease initiated by the gradual breakdown of joint cartilage. This process leads to a cycle of cartilage degradation, the release of inflammatory mediators, and compensatory synovial hypertrophy and angiogenesis. OA is the leading cause of chronic pain and disability among older adults, with knee osteoarthritis accounting for more than 80% of the disease burden.
Genicular Artery Embolization (GAE) disrupts this cycle by directly occluding the genicular arteries supplying the affected area, thereby reducing the influx of pro-inflammatory mediators that drive synovitis and neovascularization.
Presentation
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Anatomy
Indications
- Age: > 40 years
- Mild gonarthrosis, Kellgren–Lawrence grade 1–3
- VAS score of 5/10 or higher
- Failed conservative therapy
- Medication
- Intra-articular injections for a minimum of 3 months
Contra Indications
- Rheumatoid Arthritis (RA)
- Renal insufficiency
- Coagulopathy
- Previous arthroplasty or joint infection
- Occlusion of arterial access (AFC and AFS)
Workup
- MRI (described according to WORMS) 1 month prior to the procedure
- Complete the WOMAC score questionnaire, see link
- Record VAS score
- Identify painful area, see under anatomy
Material
Essentials
- Standard Angiography set
- Progreat microcatheter
- 100-micron particles
- Angioseal 6F
Non Essentials
Positioning
- Supine
- Feet first
Steps
- TOP
- Clean the area with chlorhexidine and cover it with a sterile drape.
- Perform infiltration with Lidocaine.
- Access the ipsilateral common femoral artery in antegrade direction under ultrasound guidance.
- Insert a 6F sheath.
- Administer 5000 IU of Heparin.
- Selective catheterization of the indicated genicular artery.
- Embolization with 100-micron particles to achieve a "pruned tree" appearance.
- Confirm imaging for verification.
- Use Angioseal for closure.
- SOP
Tips & Tricks
- Skin discoloration,
- - most often self resolved
- - corresponds to painfull pre-op tenderness area
- Groin hematoma
- Transient plantar numbness
Follow up
- Repeat MRI 1 month after the procedure
- Record VAS score after 6 months
- Complete the WOMAC score questionnaire after 6 months
Folder
Literature
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