Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis

Bagla, Sandeep; Piechowiak, Rachel; Hartman, Terry; Orlando, J.; Gaizo, Daniel Del; Isaacson, Ari J.

doi:10.1016/j.jvir.2019.09.018

Cited by 113 publications

(109 citation statements)

References 13 publications

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“…Laboratory and animal experiments have identified the role of neo-angiogenesis in the pathophysiology of knee OA, and this has emerged as a viable embolization target. Existing human data, including the current work, have all reported a consistent signal that GAE is safe, technically achievable, and beneficial in reducing pain, and functional limitation secondary to mild to moderate knee OA at early follow-up [8][9][10][11][12]. The current analysis is the largest reported cohort with mild to moderate knee OA undergoing GAE with a permanent embolic.…”

Section: Discussionsupporting

confidence: 61%

“…Okuno et al were the first group to describe their experience of genicular artery embolization (GAE) in patients with knee OA [8]. Since then, a small number of studies have reported on the role of GAE in the treatment of knee OA [8][9][10][11][12]. The Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the knee (GENESIS) study investigates the safety and feasibility of performing GAE in patients with mild to moderate knee OA using permanent microspheres.…”

Section: Introductionmentioning

confidence: 99%

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Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Little

Gibson

Briggs

et al. 2021

Cardiovasc Intervent Radiol

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Purpose Planned interim analysis of GENESIS; a prospective pilot study investigating the role of genicular artery embolization (GAE) in patients with mild to moderate osteoarthritis of the knee using permanent microspheres. Methods Thirty-eight patients, median age = 60 (45–83), attended for GAE using 100–300 μm permanent microspheres. All patients had mild to moderate knee OA, resistant to conservative treatments over 6 months. Knee MRI was performed at baseline, and 12 months, enabling semi-quantitative analysis using Whole-Organ Magnetic Resonance Imaging Score (WORMS). Knee Injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS) (0–100 mm) were completed at baseline, 6 weeks, 3 months (n = 32), and 1-year (n = 16). Adverse events were recorded prospectively. Results Technical success of accessing and embolizing the target genicular arteries was 84%. Six patients were not embolized: four due to a presumed risk of non-target embolization, and two due to a lack of hyperaemic target. Mean VAS improved from 60 (SD = 20, 95% CI 53–66) at baseline to 36 (SD = 24, 95% CI 28–44) at 3 months (p < 0.001) and 45 (SD = 30, 95% CI 30–60) at 1-year (p < 0.05). All KOOS subscales showed a significant improvement at 6-weeks, 3-months, and 1-year follow-up, except function in daily living, which reached borderline significance (p = 0.06) at 1-year. Four patients experienced mild self-limiting skin discoloration over the embolized territory. One patient experienced a small self-limiting groin haematoma. WORMS scores at 1-year follow-up showed significant improvement in synovitis (p < 0.05). There were no cases of osteonecrosis. Conclusion GAE using permanent microspheres in patients with mild to moderate knee OA is safe, with potential efficacy at early follow-up.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Little

Gibson

Briggs

et al. 2021

Cardiovasc Intervent Radiol

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“…This peri-articular hypervascularity is typically fed by several geniculate branches, accounting for the multiplicity of embolized vessels in our study. This synovial hypervascularity can also be seen in the setting of osteoarthritis of the knee, where early studies have shown promise in reducing vascularity and improving pain scores (Okuno et al 2015 ; Bagla et al 2020 ). Distinct vascular abnormalities such as pseudoaneurysms (Fig.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of recurrent hemarthrosis of the knee: a case series

et al. 2020

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Background: Recurrent hemarthrosis of the knee is an uncommon but potentially debilitating occurrence with multiple etiologies, including previous total knee replacement. The purpose of this study is to present data of a group of patients undergoing angiography and embolization for recurrent hemarthrosis of the knee. Patient characteristics, angiographic findings, safety and efficacy of the procedure are reported. Methods: A retrospective single centre review of patients undergoing angiography and embolization at a tertiary referral centre in Sydney, Australia from March 2006 to April 2018 was performed. A total of 25 patients undergoing a total of 29 procedures were identified (20 female, 5 male; mean age 67), the majority of which (23/25, 92%) had a history of total knee arthroplasty. Embolization was performed in 28 of the 29 procedures (97%). The embolic agent used was either polyvinyl alcohol particles (23/28), gelatin foam (3/28), detachable microcoils (1/28) or a combination of particles and coils (1/28). Results: The most commonly identified dominant vascular abnormality was periarticular synovial hypervascularity (23/25, 92%). A pseudoaneurysm was demonstrated in two patients (8%). Technical success (elimination of angiographic abnormalities) was achieved in 27 of 29 procedures (93%). There were 6 episodes of recurrence (25%) following a single embolization procedure, three of which were managed successfully with repeat embolization. There were no complications relating to skin or periarticular ischemia. Conclusion: Angiography and embolization is a safe and effective tool for the management of recurrent hemarthrosis of the knee following arthroplasty and should be considered first line treatment following failure of conservative management. Level of evidence: Level 4, Case Series.

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“…Histopathological studies have demonstrated the existence of abnormal vessels accompanying nerve fibers in tissues from various painful conditions, including osteoarthritis [94] and frozen shoulder [95]. This is the premise for performing transcatheter arterial embolization around the knee (Fig.12) and shoulder using antibiotic agents (Imipenem/cilastatin sodium) [94] or permanent embolic microspheres (100-75 µm) [96]. Imipenem/cilastatin sodium is an approved antibiotic and forms 10-70 µm insoluble particles when suspended in contrast, allowing for embolization of small vessels [94,97].…”

Section: Emerging Use Of Ablation and Embolization In The Knee And Shmentioning

confidence: 99%

“…without long lasting consequences, presumably from occlusion of the skin capillaries, has been reported with the use of permanent embolic microspheres and not with the antibiotic suspension [94,96]. These minimally invasive procedures are intended to prevent or prolong the need for major operations such as knee replacement or manipulation under anesthesia for frozen shoulder.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The Pain Crisis: Interventional Radiology's Role in Pain Management

Fletcher

Moore

Stensby

et al. 2021

American Journal of Roentgenology

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The publication of this Accepted Manuscript is provided to give early visibility to the contents of the article, which will undergo additional copyediting, typesetting, and review before it is published in its final form. During the production process, errors may be discovered that could affect the content of the Accepted Manuscript. All legal disclaimers that apply to the journal pertain. The reader is cautioned to consult the definitive version of record before relying on the contents of this document.

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Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis

Cited by 113 publications

References 13 publications

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis

Endovascular management of recurrent hemarthrosis of the knee: a case series

The Pain Crisis: Interventional Radiology's Role in Pain Management

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