MSK

GENICULATE ARTERY EMBOLIZATION

Introduction

Last updated: apr 5, 2023

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

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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

Absolute

  • Rheumatoid Arthritis (RA)
  • Renal insufficiency
  • Coagulopathy
  • Previous arthroplasty or joint infection
  • Occlusion of arterial access (AFC and AFS)

Relative

 

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

 

Materials

Essentials

  • Standard Angiography set
  • progress microcatheter
  • 100-micron particles
  • Angioseal 6F

Non-Essentials

 

Positioning the patient

  • Supine
  • Feet first

 

The procedure in 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

 

Complications

  • 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.

 

Report

Time out akkoord. Patient in rugligging. Wassen met chloorhexidine en steriel afdekken. Echografisch geen stenose in de AFCD. Antegrade toegang, met 6F sheath. 5000 IE Heparine.

...........

Angioseal

 

Literature

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  34. Bandi R, Shetty PC, Sharma RP, Burke TH, Burke MW, Kastan D. Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 2001;12:1399-1405.

  35. Maleux G, Roeflaer F, Heye S, Vandersmissen J, Vliegen AS, Demedts I, et al. Long-term outcome of transcatheter embolotherapy for acute lower gastrointestinal hemorrhage. Am J Gastroenterol 2009;104:2042-2046

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  38. Koh DC, Luchtefeld MA, Kim DG, Knox MF, Fedeson BC, Vanerp JS, et al. Efficacy of transarterial embolization as definitive treatment in lower gastrointestinal bleeding. Colorectal Dis 2009;11:53-59

  39. Lipof T, Sardella WV, Bartus CM, Johnson KH, Vignati PV, Cohen JL. The efficacy and durability of super-selective embolization in the treatment of lower gastrointestinal bleeding. Dis Colon Rectum 2008;51:301-305

 

Literature

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2004 Peterfy pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374911-Dec-2022 05:37 573 KB Preview Download
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2005 Bonnet pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374811-Dec-2022 05:37 294 KB Preview Download
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2011 Bellamy pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374811-Dec-2022 05:37 163 KB Preview Download
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2012 Rassweiler pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374911-Dec-2022 05:37 96 KB Preview Download
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2014 Okuno pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374911-Dec-2022 05:37 1 MB Preview Download
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2015 Weidner pdf 0644 2025070109252701-Jul-2025 09:25 2022121105375011-Dec-2022 05:37 1 MB Preview Download
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2017 Okuno pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374911-Dec-2022 05:37 1 MB Preview Download
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2019 Lee pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374911-Dec-2022 05:37 605 KB Preview Download
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2020 Landers pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374911-Dec-2022 05:37 453 KB Preview Download
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2021 Isaacson pdf 0644 2025070109252701-Jul-2025 09:25 2022121105374811-Dec-2022 05:37 1 MB Preview Download
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2021 Torkian pdf 0644 2025070109252701-Jul-2025 09:25 2022121105375011-Dec-2022 05:37 1 MB Preview Download

DISCLAIMER

The information contained herein has been obtained from sources believed to be reliable. However, no warranty as to the accuracy, completeness or adequacy of such information is implied. No liability is accepted for errors, omissions or inadequacies in the information contained herein or for interpretations thereof. The reader assumes sole responsibility for the selection of these materials to achieve its intended results. The opinions expressed herein are subject to change without notice.

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