Genicular Artery Embolization (GAE)

Genicular artery embolization (GAE) is a minimally invasive endovascular procedure designed to manage chronic knee pain, particularly in patients suffering from osteoarthritis. Post-operative patients with total knee replacements (TKR) for example, with pain symptoms or with recurrent haemarthrosis, are also indications for GAE. This intervention targets the genicular arteries, which are a network of vessels supplying blood to the knee joint.

 

The procedure involves the selective catheterization of the genicular arteries using fluoroscopic guidance. A microcatheter is navigated through the femoral artery, typically via an access point in the groin, towards the target vessels in the knee. Once the catheter is in place, embolic agents such as microspheres or particles are injected to occlude the blood flow within the genicular arteries. The embolic agents are precisely chosen based on size and material to ensure adequate blockage while minimizing the risk of non-target embolization.

 

By reducing the blood flow to the inflamed synovium and subchondral bone, GAE alleviates pain and decreases the inflammatory response. The mechanism is believed to involve the reduction of pro-inflammatory cytokines and growth factors, which are pivotal in the pathophysiology of osteoarthritis-related pain. This decreased vascular supply mitigates the synovitis and neovascularization that contribute to the chronic pain cycle in osteoarthritis.

 

GAE is considered particularly beneficial for patients who have not responded to conventional treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular steroid injections, or physical therapy, and who are not ideal candidates for surgical interventions like total knee arthroplasty. The procedure is generally performed under local anesthesia with conscious sedation, and patients often experience significant pain relief within weeks post-procedure, with minimal downtime and a relatively low risk of complications.

 

Clinical studies and emerging evidence have shown promising outcomes, making GAE a viable alternative in the multidisciplinary approach to managing refractory knee osteoarthritis pain. As with any medical procedure, careful patient selection and thorough pre-procedural imaging and planning are critical to maximize therapeutic efficacy and minimize potential risks.