Genicular Artery Embolization: Beyond the Placebo Effect, and Planning for the Long Road Ahead

2022 ◽  
Vol 33 (1) ◽  
pp. 11-13
Author(s):  
Jin Woo Choi
Keyword(s):  
Placebo Effect ◽  
Artery Embolization ◽  
Genicular Artery

scholarly journals Angiographic Analysis of the Anatomical Variants in Genicular Artery Embolization

2021 ◽  
Author(s):  
Sandeep Bagla ◽  
Rachel Piechowiak ◽  
Abin Sajan ◽  
Julie Orlando ◽  
A Diego Hipolito Canario ◽  
...  
Keyword(s):  
Procedure Time ◽  
Technical Success ◽  
Artery Embolization ◽  
Novel Technique ◽  
Anterior Tibial ◽  
Branching Patterns ◽  
Genicular Artery ◽  
Arterial Anatomy ◽  
Lateral Superior Genicular Artery ◽  
Angiographic Findings

Abstract Purpose: Genicular artery embolization (GAE) has been proposed as a novel technique to treat painful synovitis related to osteoarthritis. An in-depth understanding of the genicular arterial anatomy is crucial to achieve technical success and avoid nontarget-related complications. Given the lack of previous angiographic description, the present study analyzes genicular arterial anatomy and proposes an angiographic classification system. Materials and Methods: Angiographic findings from 41 GAEs performed during two US clinical trials from January 2017 to July 2019 were reviewed to analyze the anatomical details of the following vessels: descending genicular artery (DGA), medial superior genicular artery (MSGA), medial inferior genicular artery (MIGA), lateral superior genicular artery (LSGA), lateral inferior genicular artery (LIGA), and anterior tibial recurrent artery (ATRA). The diameter, angle of origin, and anastomotic pathways were recorded for each vessel. The branching patterns were classified as: medially, M1 (3/3 arteries present) vs M2 (2/3 arteries present); and laterally, L1 (3/3 arteries present) vs L2 (2/3 arteries present). Results: A total of 91 genicular arteries were embolized: DGA (26.4%), MIGA (23.1%), MSGA (22.0%), LIGA (14.3%), and LSGA/ATRA (14.3%). The branching patterns were: medially = M1, 74.4% (n = 29), M2, 25.6% (n = 10); and laterally = L1, 94.9% (n = 37), L2, 5.1% (n = 2). A common origin for MSGA and LSGA was noted in 11 patients (28.2%). A direct DGA origin from the popliteal artery was reported in three patients (7.7%, n = 3). Conclusions: A thorough understanding of the geniculate arterial anatomy is important for maximizing postprocedural pain reduction while minimizing complications, procedure time, and radiation exposure during GAE.

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

2020 ◽  
Vol 31 (7) ◽  
pp. 1096-1102 ◽  
Author(s):  
Sandeep Bagla ◽  
Rachel Piechowiak ◽  
Terry Hartman ◽  
Julie Orlando ◽  
Daniel Del Gaizo ◽  
...  
Keyword(s):  
Knee Pain ◽  
Artery Embolization ◽  
Genicular Artery

scholarly journals Genicular artery embolization as a novel treatment for mild to moderate knee osteoarthritis: protocol design of a randomized sham-controlled clinical trial

Trials ◽  
2022 ◽  
Vol 23 (1) ◽  
Author(s):  
T. A. van Zadelhoff ◽  
A. Moelker ◽  
S. M. A. Bierma-Zeinstra ◽  
P. K. Bos ◽  
G. P. Krestin ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Knee Osteoarthritis ◽  
Pain Threshold ◽  
Pressure Pain Threshold ◽  
Scale Efficiency ◽  
Control Group ◽  
Artery Embolization ◽  
Sham Treatment ◽  
Pressure Pain ◽  
Genicular Artery

Abstract Introduction Knee osteoarthritis is a common disease with pain as the most prevalent symptom. Previous cohort studies have shown genicular artery embolization to reduce pain symptoms in patients with mild to moderate knee osteoarthritis. Patients resistant to conservative therapy but not eligible yet for surgical treatment due to young age or comorbidities may profit from an effective and sustained pain reduction treatment. This study is a randomized sham-controlled trial to evaluate the efficacy of genicular artery embolization in patients with knee osteoarthritis. Methods and analysis Fifty-eight patients with mild-to-moderate knee osteoarthritis will be recruited and randomly allocated to the treatment or control group in a 1:1 ratio. Participants in the treatment group will undergo genicular artery embolization. Patients in the control group will undergo sham treatment. Outcome measurements will be assessed at baseline and after 1, 4, 8, and 12 months with questionnaires, pressure pain threshold testing, and MR imaging. The MR imaging protocol is designed to (semi)quantitatively assess osteoarthritis in the knee joint. The primary outcome is the change from baseline of the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale after 4 months. Secondary outcomes include change in osteoarthritis-related questionnaires, pressure pain threshold, and OA-related MRI features, particularly synovitis and bone marrow lesions. Ethics and dissemination This trial will determine the efficacy of genicular artery embolization compared to a sham treatment. This is of importance to assess before proceeding to larger-scale efficiency studies and, ultimately, implementing this treatment into day to day clinical practice. Trial registration ClinicalTrials.gov NCT03884049. Registered on 21 March 2019

Genicular Artery Embolization to Improve Pain and Function in Early-Stage Knee Osteoarthritis—24-Month Pilot Study Results

2020 ◽  
Vol 31 (9) ◽  
pp. 1453-1458
Author(s):  
Steve Landers ◽  
Rachael Hely ◽  
Richard Page ◽  
Nick Maister ◽  
Andrew Hely ◽  
...  
Keyword(s):  
Pilot Study ◽  
Knee Osteoarthritis ◽  
Early Stage ◽  
Artery Embolization ◽  
Study Results ◽  
Genicular Artery ◽  
And Function

A Review of Musculoskeletal Embolization to Treat Pain Outside of the Knee

2021 ◽  
Vol 38 (05) ◽  
pp. 515-517
Author(s):  
Abin Sajan ◽  
Sandeep Bagla ◽  
Ari Isaacson
Keyword(s):  
Knee Joint ◽  
Chronic Inflammation ◽  
Shoulder Pain ◽  
Case Reports ◽  
Adhesive Capsulitis ◽  
Lateral Epicondylitis ◽  
Artery Embolization ◽  
The Past ◽  
Genicular Artery ◽  
Future Potential

AbstractChronic inflammation leading to musculoskeletal pain has garnered interest in the past decade with the success of genicular artery embolization for knee pain secondary to osteoarthritis. Outside the knee joint, musculoskeletal embolization has been applied to other anatomical locations, mainly shoulder pain secondary to adhesive capsulitis and elbow pain secondary to lateral epicondylitis. The success of these early trials and other case reports highlights the efficacy of musculoskeletal embolization and its future potential.

Genicular Artery Embolization for Recurrent Hemarthrosis of the Knee Following Total Knee Arthroplasty: A Single Centre Experience

2020 ◽  
pp. 084653711989955
Author(s):  
Stephen P. Power ◽  
Brooke Cairns ◽  
Vikramaditya Prabhudesai ◽  
Dan Marcuzzi ◽  
James P. Waddell ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Clinical Symptoms ◽  
Clinical Success ◽  
Artery Embolization ◽  
Single Centre Experience ◽  
Skin Erythema ◽  
Ischemic Complications ◽  
Genicular Artery ◽  
Total Knee

Purpose: To retrospectively review the safety and efficacy of genicular artery embolization procedures performed at our institution in patients presenting with recurrent knee hemarthrosis following total knee arthroplasty (TKA). Materials and Methods: A total of 13 consecutive patients (average age: 68; range 51-84, 62% female) were identified who underwent 14 genicular artery embolization procedures after presenting with recurrent hemarthrosis after TKA. Patient charts were retrospectively reviewed for demographic information, pre-embolization investigations, and details of embolization procedure including complications, technical success, and clinical success. Each patient had failed initial conservative therapy and all patients had a diagnostic aspiration performed by the referring physician prior to the procedure. The average time between TKA and embolization in our cohort was 21 months. Results: All procedures performed were technically successful, defined as elimination of periprosthetic hypervascular blush. An average of 3.6 genicular vessels were embolized in each patient; 355 to 500 µm polyvinyl alcohol (PVA) particles were used in each case. There were no cases of transient cutaneous ischemia, skin erythema, or skin necrosis. Clinical success was obtained in 85.7% of cases, defined by elimination of the presenting clinical symptoms (knee pain and swelling) during continued follow-up by the referring clinician. Conclusion: Particle embolization is a safe and effective treatment for recurrent hemarthrosis after arthroplasty and our experience suggests that utilizing particle sizes of greater than 300 µm appears to be important in order to avoid cutaneous ischemic complications.

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