Geniculate artery embolization is an interventional radiology procedure used to treat knee pain due to osteoarthritis by reducing blood flow to the lining of the knee, known as the synovium. In osteoarthritis patients, pain is often caused by an increased blood flow to the knee related to inflammation. GAE is a highly effective procedure for people:
- With osteoarthritic knee pain
- Who have not responded to medication, therapies, and/or joint injections
- Who are not ready to have a knee replacement or are not good candidates for surgery
Generally, an MRI of the knee with contrast is recommended to see if GAE is the right procedure for you.
GAE is an outpatient procedure that uses moderate sedation. During the procedure, a small catheter is inserted into the femoral artery in the groin and guided using moving X-ray imaging to the arteries carrying blood to the lining of the knee. Tiny beads are injected through the catheter into these arteries, blocking them and reducing blood supply to the area of inflammation. During the procedure, images of the patient’s leg can be viewed in real time, making the procedure precise and effective. After the procedure, patients will experience temporarily increased knee pain, but over the course of several weeks there will be a reduction or elimination of pain.
Patients who have chronic knee pain due to osteoarthritis that has not responded enough to conventional therapies may benefit from GAE. Most patients will have been through such therapies as anti-inflammatory drugs, physical therapy, muscular strengthening, and knee injections. Other indications may include:
- Moderate to severe knee pain
- Knee pain when climbing stairs
- Knee pain when at rest or in bed
- Local knee tenderness
- No development of bony deformity or sclerosis
- Failed conservative treatment
- Do not wish to or are ineligible to undergo knee replacement surgery
The following conditions may disqualify a patient as a candidate for GAE:
- Current or previous history of cigarette smoking
- Advanced arthritis based on X-ray
- Infection or malignancy in the knee area
- GAE is a minimally invasive procedure that can bring relief from knee pain and can be performed as an outpatient surgery. It is low risk and effective, plus it has a much faster recovery time than surgery.
- The procedure only requires a small incision in the skin.
- Seventy percent of patients treated with GAE will have significant reduction of pain.
- Geniculate artery embolization uses a very small dose of radiation, and the benefit from accurate diagnosis and successful treatment far outweighs the risk. Please see ARA’s information on Radiation Safety.
- If you have had an allergic reaction to contrast material in the past, your radiologist may recommend that you take medication for 24 hours before the procedure to reduce risk. While extremely rare, there is a risk of serious allergic reaction to iodinated contrast. ARA radiologists and staff are well prepared in the event of such a reaction.
- In very rare cases, the catheterization may injure a vessel, which can cause bleeding or vessel blockage. This may require additional procedures to clear the vessel or stop the bleeding.
- In rare cases, patients develop minor skin discoloration (livido reticularis) that quickly passes or small skin ulcerations (sores) that will heal.
- GAE is typically done in an ARA imaging center. The procedure takes about 90 minutes.
- You may be asked to remove all metal and jewelry, and you will be asked to change into a gown.
- Before the exam, a paramedic or nurse will start in intravenous (IV) line in your arm or hand.
- Electrodes are placed on your chest to monitor your heart function during the procedure.
- You will be positioned comfortably on the exam table. At this point, a dose of sedative will be delivered through the IV to help you relax. The area where the catheter will be inserted may be shaved and will be cleaned and numbed with local anesthetic, which may sting briefly.
- The radiologist will make a tiny nick in your skin and guide the catheter into the artery (the femoral artery in the groin), then guide the catheter through the blood vessels until it reaches the area being treated. At this point, contrast material is injected. You may feel a warm sensation as the contrast material enters your bloodstream. Contrast material helps make the vessels appear more clearly on the image.
- An X-ray camera will produce images which can be viewed in real time on a monitor by the interventional radiologist.
- Once the catheter reaches the arteries that are causing the inflammation in the knee, the interventional radiologists will release tiny beads that will block the arteries partially or completely, causing the blood flow to slow and relieving pain.
- More images may be taken to make sure the embolization was completed effectively.
- When the procedure is finished, the catheter is removed, and pressure is applied to the incision site.
- You may be asked to rest in bed for 2 to 4 hours after the procedure.
- Because you will be sedated, you should have someone with you who can drive you home. You should not drive for 24 hours after your exam.
- You may resume light activities during the first week after the procedure.
- Please let your physician and your IR coordinator know of all medications you are taking and if you have allergies, especially to iodinated contrast material. Also let your physician and IR coordinator know about recent illnesses or ongoing medical conditions.
- If you take any blood-thinning medications, aspirin, or products containing aspirin, please contact our office for instructions on discontinuing the medications prior to your procedure.
- You will be asked to remove clothes over the area being examined and to wear a gown.
- Since you will be given sedation, please plan to bring a friend or relative to drive you home. You will be kept for observation at the facility until you are cleared to leave and should not plan to drive for 24 hours following the exam.
- You may resume light activities during the first week after the procedure. Your physician will clear you for more intensive activities after your follow-up appointment.
- You will have knee pain after the procedure that will steadily lessen as the procedure takes effect.
- You should refrain from excessive high-impact exercise for 2 weeks after the procedure.
To schedule a consult for geniculate artery embolization (GAE), please speak with your health care provider and call our interventional team at (512) 467-9729.