Geniculate Artery Embolization Research Articles

Effectiveness of Geniculate Artery Embolization for Chronic Pain after Total Knee Replacement—A Pilot Study

PurposeTo evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA). Materials and MethodsTwelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points. ResultsA mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week. ConclusionGAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months.

Geniculate Artery Endovascular Embolization Post-Total Knee Arthroplasty for Hemarthrosis Treatment: A Systematic Review of the Literature.

To provide an updated systematic review on the use of geniculate artery embolization (GAE) in the management of recurrent hemarthrosis post-total knee arthroplasty (TKA). A systematic literature review was conducted, and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications, and follow-up data were extracted and analyzed using STATA 14.1. A total of 20 studies (9 case reports, 11 case series; n= 214) were included for review. In all cases, patients underwent coil embolization of one or more geniculate arteries. Procedure success was reported in 94.8% (n=203/214) of cases without perioperative adverse events. Improvement of symptoms was seen in 72.6% (n=119/164) of cases, with 30.7% (n=58/189) of cases requiring repeat embolization. Recurrent hemarthrosis occurred in 22.2% (n=22/99) of cases over a mean follow-up of 48 months. GAE appears to be a safe and effective treatment for recurrent hemarthrosis following TKA. Future studies in the form of randomized controlled trials should be conducted to further evaluate such embolization techniques and compare outcomes between GAE and standard techniques. Conservative management of post total knee arthroplasty (TKA) hemarthrosis is successful in only one third of cases. Geniculate artery embolization (GAE) has recently gained attention due to its minimally invasive nature compared to open or arthroscopic synovectomy promising faster rehabilitation, decreased infection rates and less additional surgeries. The purpose of this article was to summarize current literature, provide an updated review on the use of GAE in the management of recurrent hemarthrosis post-TKA and describe immediate and long-term outcomes in an effort to help optimize current treatment algorithms.

Role of geniculate artery embolization in the treatment of knee pain secondary to osteoarthritis

BackgroundOsteoarthritis (OA) is a leading cause of chronic knee pain and disability with a reported prevalence of 25–30% of the population. Knee OA has traditionally been thought as a degenerative disease only related to chronic repetitive injury “wear and tear” mechanism, yet it is now considered as a much more complex disease of inflammatory nature induced by cytokines and inflammatory mediators through abnormal neo-vascularization (angiogenesis). The rational of geniculate artery embolization (GAE) is based on the hypothesis that suggesting a direct relationship between the abnormal angiogenesis and the chronic knee pain. As a novel treatment option based on occlusion of these abnormal neo-vessels via geniculate artery embolization, we postulated that such a mechanism will relieve pain and improve the quality of life. GAE has been previously approved as a safe and effective treatment in cases of post-knee arthroplasty hemarthrosis.PurposeTo evaluate the feasibility, safety, and efficacy of geniculate artery embolization for OA-related knee pain.Materials and methodsSixteen patients with knee pain secondary to chronic OA refractory to conservative therapies for at least 6 months and not yet fit for total knee replacement were enrolled in a prospective single arm interventional study. GAE was performed using 150–300 μm microspheres. Patients were assessed and followed up using the visual analogue scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for the overall knee function at baseline and at 1 week, 1, 3, and 6 months post-embolization.ResultsA total 16 patients presented by knee pain secondary to chronic OA were enrolled. All of them showed a remarkable improvement in the VAS and WOMAC scores, with better clinical outcome after GAE. Pre- versus post-embolization ± MDs in VAS score from 8.38 ± 0.81 (baseline) to 2.88 ± 1.54 after 6 months (post-embolization) equivalent to 66.66% improvement. There was also a satisfactory improvement in the WOMAC scores, with ± MDs drop from 77.94 ± 10.62 (baseline) to 49.69 ± 15.43 (post-embolization) equivalent to 37.41% improvement. No severe or life-threatening complications were reported.ConclusionsGAE holds promise as an effective minimally invasive procedure for the treatment of knee pain secondary to OA and could be introduced as a safe technique with no serious complications.

Geniculate artery embolization for the treatment of refractory hemarthrosis following meniscal repair

The present case report describes a unique example of recurrent hemarthrosis and associated arthralgia in a 41-year-old male after laparoscopic left medial meniscus repair, which failed to resolve with conservative treatment and surgical revision. Due to the worsening symptomatology as evidenced by increasing volume of aspirated blood during serial arthrocenteses and gradually decreasing range of motion of the joint despite surgical revision, geniculate artery embolization (GAE) was recommended. GAE is not routinely utilized to treat postoperative complications following meniscus repair; however, in the present case, utilizing selective angiographic embolization of the geniculate arteries led to successful treatment of recurrent spontaneous hemarthrosis and associated arthralgia. At this point, the patient has been symptom free for nine months. Relevant patient history, along with progress monitoring data from follow-up visits, demonstrates that spontaneous hemarthrosis and associated arthralgia following laparoscopic medial meniscus repair may be successfully treated with GAE. This is a noteworthy finding which underlines the importance of investigating alternative therapies in treatment refractory cases. However, a thorough evaluation of the appropriateness of this intervention is of paramount importance and its potential benefits need to be determined on a case-by-case basis.

Assessing the Effects of Geniculate Artery Embolization in a Nonsurgical Animal Model of Osteoarthritis

PurposeTo create a nonsurgical animal model of osteoarthritis (OA) to evaluate the effects of embolotherapy during geniculate artery embolization (GAE). Materials and MethodsFluoroscopy-guided injections of 700 mg of sodium monoiodoacetate were performed into the left stifle in 6 rams. Kinematic data were collected before and after induction. At 10 weeks after induction, Subjects 1 and 4–6 underwent magnetic resonance (MR) imaging with dynamic contrast enhancement (DCE) and Subjects 1, 3, and 4–6 underwent angiography with angiographic scoring to identify regions with greatest disease severity for superselective embolization (75–250-μm microspheres). Target vessel size was measured. At 24 weeks after angiography, DCE-MR imaging, angiography, and euthanasia were performed, and bilateral stifles were harvested. Medial/lateral tibial and femoral condylar, patellar, and synovial samples were cut, preserved, decalcified, and scored using the Osteoarthritis Research Society International criteria. The stifle and synovium Whole-Organ Magnetic Resonance Imaging Score and Multicenter Osteoarthritis Study score were determined. The volume transfer constant (Ktrans) and extracellular volume fraction (ve) were calculated from DCE-MR imaging along the lateral synovial regions of interest. ResultsThe mean gross and microscopic pathological scores were elevated at 38 and 61, respectively. Mean synovitis score was elevated at 9.2. Mean pre-embolization and postembolization angiographic scores were 5 and 3.8, respectively. Mean superior, transverse, and inferior geniculate artery diameters were 3.1 mm ± 1.21, 2.0 mm ± 0.50, and 1.6 mm ± 0.41 mm, respectively. Mean pre-embolization and postembolization cartilage and synovitis scores were elevated at 35.13 and 73.3 and 5.5 and 9.2, respectively. The Ktrans/ve values of Subjects 4, 5, and 6 were elevated at 0.049/0.38, 0.074/0.53, and 0.065/0.51, respectively. Altered gait of the hind limb was observed in all subjects after induction, with reduced joint mobility. No skin necrosis or osteonecrosis was observed. ConclusionsA nonsurgical ovine animal knee OA model was created, which allowed the collection of angiographic, histopathological, MR imaging, and kinematic data to study the effects of GAE.

Abstract No. 348 ▪ FEATURED ABSTRACT Assessing effects of geniculate artery embolization in a non-surgical animal model of osteoarthritis

Abstract No. 348 ▪ FEATURED ABSTRACT Assessing effects of geniculate artery embolization in a non-surgical animal model of osteoarthritis

Geniculate Artery Embolization: Role in Knee Hemarthrosis and Osteoarthritis.

Roughly 37% of Americans 60 years of age and older experience chronic pain due to osteoarthritis (OA) of the knee. After conservative treatment (pharmacologic, physical therapy, and joint injections) fails, patients often require total knee arthroplasty to alleviate pain and regain knee function. Given the high economic burden of surgery paired with its invasive nature, many patients with this degenerative joint disease seek alternative treatment. Moreover, many patients with severe knee OA who also have comorbidities that preclude surgery-most often morbid obesity-are left without options. Geniculate artery embolization (GAE) is a minimally invasive intra-arterial intervention that was originally developed for the treatment of knee hemarthrosis that has recently been adapted for symptomatic knee OA. Through selective embolization of geniculate branches corresponding to the site of knee pain, GAE inhibits the neovascularity that contributes to the catabolic and inflammatory drive of OA. Preliminary trials over the past decade have demonstrated promising clinical results, including decreased pain and improved function and quality of life after treatment. Given such success, GAE provides another minimally invasive treatment option for knee OA to patients who feel reluctant to undergo or are ineligible for surgery. The authors review the radiographic manifestations and current standard of treatment of OA and hemarthrosis of the knee. Procedural technique, embolic selection, and clinical evidence for GAE in the treatment of OA and hemarthrosis of the knee are also explored. The online slide presentation from the RSNA Annual Meeting is available for this article. ©RSNA, 2021.

Potential New Treatments for Knee OA: A Prospective Review of Registered Trials

We aimed to evaluate potential new treatments for knee osteoarthritis (OA). The National Institute of Health ClinicalTrials.gov database was searched for “Osteoarthritis, Knee”. We found 565 ongoing interventional studies with a total planned enrollment of 111,276 subjects. Ongoing studies for knee OA represent a very small fraction of the registered clinical trials, but they are over a quarter of all knee trials and over two thirds of all OA studies. The most researched topic was arthroplasty, with aspects such as implant design changes, cementless fixation, robotic guidance, pain management, and fast track recovery. Intraarticular injections focused on cell therapies with mesenchymal stem cells sourced from adipose tissue, bone marrow, or umbilical cord. We could see the introduction of the first disease modifying drugs with an impact on knee OA, as well as new procedures such as geniculate artery embolization and geniculate nerve ablation.

3:45 PM Abstract No. 8 Geniculate artery embolization for osteoarthritis: a systematic review of patient characteristics, treatment protocols, angiographic findings, and outcomes

3:45 PM Abstract No. 8 Geniculate artery embolization for osteoarthritis: a systematic review of patient characteristics, treatment protocols, angiographic findings, and outcomes

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis.

Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1-50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74-93%, I 2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03-1.63, I 2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15-40%, I 2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6-25%, I 2: 0%, p = 0.87). The rate of complications were as follows: any complication - 19% (95% CI: 11-32%, I 2: 0%, p = 0.81); major complications-8% (95% CI: 3-19%, I 2: 0%, p = 0.96); minor complications-18% (95% CI: 10-31%, I 2: 0%, p = 0.79); inguinal hematoma-9% (95% CI: 4-19%, I 2: 0%, p = 1.00); skin necrosis-15% (95% CI: 7-29%, I 2: 0%, p = 0.62); and incision breakdown-7% (95% CI: 3-17%, I 2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA.

Geniculate Artery Embolization in Patients With Recurrent Hemarthrosis After Knee Arthroplasty: A Retrospective Study

BackgroundRecurrent hemarthrosis after knee arthroplasty is an uncommon and disabling complication of this frequently performed procedure. Selective endovascular embolization of the geniculate arteries is one of the therapeutic options to manage this complication. The purpose of this study is to analyze the effectiveness of this treatment in patients suffering from recurrent hemarthrosis after knee arthroplasty. MethodsWe performed a retrospective study of 31 patients (39 embolization procedures) with recurrent hemarthrosis after knee arthroplasty. There were 17 men and 14 women with a median age of 67 years (range 48-90). All patients were referred for geniculate artery embolization between January 2007 and November 2016. ResultsTwenty-seven procedures were executed on the right side and 12 on the left side. Total knee arthroplasty was performed on 29 patients, only 2 patients underwent unicompartmental knee arthroplasty. Embolization of the superior geniculate arteries was achieved in all patients. In 12 of 39 procedures (31%), at least 1 of the inferior geniculate arteries could not be catheterized, therefore embolization was achieved through collaterals. Symptomatic improvement was observed in 26 of 31 patients (84%). Discomfort or mild postprocedural pain was observed in most patients, needing only minor pain medication, mostly resolving within 24 hours. Two patients presented with a severe complication: a 48-year-old male patient developed septic arthritis and an 85-year-old hypertensive female patient treated with anticoagulants showed aseptic necrosis of the femoral condyles. ConclusionEmbolization of geniculate arteries is a safe and effective treatment in recurrent hemarthrosis post knee arthroplasty. Clinical improvement was seen in most patients.

03:00 PM Abstract No. 23 Geniculate artery embolization (GAE) for osteoarthritis (OA)-related knee pain: results from a multicenter US trial

Knee OA is a common cause of pain and disability, with many patients relying on chronic pain medications and/or joint injections. These options unfortunately result in short-term relief, or have associated increased morbidity, and knee replacement surgery may ultimately be performed. Researchers have postulated that synovial neovascularity develops as a result of inflammation and subsequently leads to knee pain. While previous overseas reports of success with GAE have been published, we present our final results from a prospective US multicenter clinical trial. 20 subjects with OA with pain greater than 50 mm (Visual Analog Scale 100mm) refractory to conservative therapy were enrolled in the study (clinicaltrials.gov NCT02850068). Subjects were excluded for: Kellgren Lawrence (KL) Stage 4, rheumatoid arthritis, infection, previous arthroplasty, renal insufficiency, or uncorrectable coagulopathy. GAE was performed using 75 or 100 um Embozene Microspheres (Boston Scientific, Marlborough, MA) in 20 subjects at 2 US centers. Subjects were assessed with MRI, Visual Analog (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain and disability scales, before and after the procedure. Adverse events were also recorded at all time points. Median baseline OA was KL stage III and baseline VAS was 72 mm (SD 14). Neovascularity was identified in the area of pain in all cases by arteriography (n=20) and GAE was technically successful in all subjects (n=20). GAE significantly improved pain at primary endpoint of 6 months as measured by VAS and WOMAC (n=20, baseline VAS 76 mm, mean decrease -47 mm, p<0.01; baseline WOMAC 61, mean decrease 32, p<0.01). No major adverse events were seen related to the procedure, however transient cutaneous ischemia was noted in 14/20 and 2 subjects experienced transient plantar sensory parasthesias. GAE is a technically feasible and effective technique in the short term to reduce pain secondary to knee osteoarthritis.

04:03 PM Abstract No. 30 Geniculate artery embolization (GAE) in the management of recurrent hemarthrosis after total knee arthroplasty (TKA)

04:03 PM Abstract No. 30 Geniculate artery embolization (GAE) in the management of recurrent hemarthrosis after total knee arthroplasty (TKA)

Abstract No. 613 Intraarticular sodium monoiodoacetate injection induced osteoarthritis in sheep: a non-surgical large animal model for geniculate artery embolization

Abstract No. 613 Intraarticular sodium monoiodoacetate injection induced osteoarthritis in sheep: a non-surgical large animal model for geniculate artery embolization

Abstract No. 453 In vitro characteristics of imipenem–cilastatin (IPM-CS) particles as embolic agents for geniculate artery embolization: morphology and stability in solution

Imipenem–cilastatin (IPM-CS) has been successfully used in particle embolization for osteoarthritis. Information regarding the physical characteristics of IPM-CS particles is lacking. The purpose of this study was to investigate the basic characteristics of IPM-CS particles as embolic agents as well as its optimal conditions. Three samples of 50 mg IPM-CS suspensions were made with contrast in each condition: volume of contrast: 500 μL, 1000 μL; mixing time with vortex mixer: 5s, 10s, 30s. The size of particles was measured using light microscopy. Field of view (FOV) was randomly determined and the size of all visible particles in FOV was measured until the total particle count exceeded 500 in each sample. The particle size distribution in each of the 6 conditions was compared. To investigate time-depend particle changes, 3 samples were made with 50 mg IPM-CS in 1000 μL contrast and a fixed mixture time of 10 s. Particle size was measured immediately, 1 and 3 hours after mixing. The particle size distributions were compared using Kolmogorov-Smirnov test. Over 85% of IPM-CS particles were small in size (0-30 μm) under all preparation conditions. A significant difference in size distribution was seen between 5s-1000μL vs 30s-1000μL groups, primarily in a greater portion of < 10 μm particles with increased mixture time (42.8% vs 47.0% of particle < 10 μm, P = 0.01). Particle size distribution and density in suspension were strongly affected by contrast volume in all the mixture time with 500μL vs 1000μL contrast (61.1-65.5% vs 42.8-47.0% of particles < 10 μm, P < 0.01), suggestive for its soluble feature in contrast. Small, but statistically significant differences in size distributions were observed with elapsed time after mixture. IPM-CS for embolization in osteoarthritis generates particles smaller than 30 μm. IPM-CS particles are relatively stable for mechanical mixture although smaller particles increased with mixture time. The particle size distribution can be affected by both contrast volume and elapsed time. Further understanding of the physicochemical properties of IPM-CS particles may improve optimization for therapeutic delivery.

03:54 PM Abstract No. 29 A survey of geniculate artery embolization practice patterns among interventional radiologists

03:54 PM Abstract No. 29 A survey of geniculate artery embolization practice patterns among interventional radiologists

3:45 PM Abstract No. 206 Magnetic resonance imaging finding in patients undergoing geniculate artery embolization (GAE) for osteoarthritis-related knee pain: results from a multicenter U.S. trial

3:45 PM Abstract No. 206 Magnetic resonance imaging finding in patients undergoing geniculate artery embolization (GAE) for osteoarthritis-related knee pain: results from a multicenter U.S. trial

3:18 PM Abstract No. 203 Selective geniculate artery embolization for management of recurrent hemarthrosis after total-knee arthroplasty

3:18 PM Abstract No. 203 Selective geniculate artery embolization for management of recurrent hemarthrosis after total-knee arthroplasty

4:21 PM Abstract No. 210 Geniculate artery embolization for osteoarthritis-related knee pain: interim results from a multicenter U.S. trial

Knee OA is a common cause of pain and disability, with many patients relying on chronic pain medications and/or joint injections. These options unfortunately result in short-term relief, or have associated increased morbidity, and knee replacement surgery may ultimately be performed. Researchers have postulated that synovial neovascularity develops as a result of inflammation and subsequently leads to knee pain. While previous overseas reports of success with GAE have been published, we present our interim results from a prospective US multicenter clinical trial. 20 subjects with OA with pain greater than 50 mm (Visual Analog Scale 100 mm) refractory to conservative therapy are being recruited for the study (clinicaltrials.gov NCT02850068). Subjects were excluded for: Kellgren Lawrence (KL) Stage 4, rheumatoid arthritis, infection, previous athroplasty, renal insufficiency, or uncorrectable coagulopathy. GAE was performed using 75 or 100 um microspheres in 13 subjects at 2 US centers. Subjects were assessed with MRI, Visual Analog (VAS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain and disability scales before and after the procedure. Adverse events were also recorded at all time points. Median baseline OA was KL stage III. Neovascularity was identified in the area of pain in all cases by arteriography (n = 13) and GAE was technically successful in all subjects (n = 13). 8/13 subjects were eligible for clinical follow-up at present. GAE significantly improved pain at 1 month as measured by VAS (n = 8, mean -58 mm, p = 0.016). Global WOMAC score also decreased (n = 8 mean -36.3, p = 0.0008). No major adverse events were seen related to the procedure. Interim results are promising for GAE to safely reduce pain and disability for mild to moderate knee osteoarthritis.

3:00 PM Abstract No. 201 Classification of geniculate artery anatomy and implications for geniculate artery embolization: experience from a U.S. pilot study

3:00 PM Abstract No. 201 Classification of geniculate artery anatomy and implications for geniculate artery embolization: experience from a U.S. pilot study