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
1 Superior Patellar
2 Descending Genicular
3 Lateral Superior Geniculate
4 Medial Superior Geniculate
5 Median Genicular
6 Medial Inferior Genicaular
7 Lateral Inferior Genicular
8 Anterior Tibial Recurrent
1 Superior Patellar
2 Descending Genicular
3 Lateral Superior Geniculate
4 Medial Superior Geniculate
5 Median Genicular
6 Medial Inferior Genicaular
7 Lateral Inferior Genicular
8 Anterior Tibial Recurrent
Branching variations
- MGA from PA
- MGA from SLGA
- MGA from SMGA
- Common origo IMGA and ILGA
- Common origo MGA with SMGA and SLGA
Connections
- DGA to SMGA
- UB connecting PA to SMGA
- UB connecting PA to DGA
- IMGA from MSA
- ILGA from LSA
- UB connecting PA to SLGA
Vascular supply by location
- Medial: Descending Genicular Artery (DGA), Superior Medial Genicular Artery (SMGA), Inferior Medial Genicular Artery (IMGA)
- Lateral: Superior Lateral Genicular Artery (SLGA), Inferior Lateral Genicular Artery (ILGA)
- Patellofemoral: Saphenous branch of DGA (19% of cases), superficial patellar branch of SLGA (100%), terminal branch of IMGA (69%), terminal branch of ILGA (88%)*
- DGA ↔ SMGA — most common (85%), mean diameter 850 microns; risk of non-target embolisation down the leg via retrograde flow. Consider entering via the latter
- SMGA ↔ Popliteal Artery via unnamed branch (15%) — risk of embolisation down the leg
- DGA ↔ Popliteal Artery via unnamed branch (10%) — unnamed branch could be mistaken for SMGA
- ILGA ↔ Lateral Sural Artery (15%) — supplies the lateral gastrocnemius muscle; considered less clinically critical than the medial sural anastomosis
- SLGA ↔ Popliteal Artery via unnamed branch (one case) — diameter 1020 microns, risk of embolisation re-entering the popliteal artery
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 (reported 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
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Avoid Embolizing these Arteries
- The Middle Genicular Artery (MGA) — it supplies the anterior and posterior cruciate ligaments. It's a particular concern because the SMGA shares an origin with the MGA in 25% of cases, and there is even a triple SMGA-MGA-SLGA shared origin in 5% of cases
- Watch out for the IMGA collateral to the Medial Sural Artery (5%) — highest clinical concern; the medial sural artery supplies the tibial nerve, so embolisation here risks paraesthesia and weakness
- 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