Geniculate Artery Embolization

Osteoarthritis is the most common cause of joint pain, affecting 32.5 million adults in the US. While severe disease is managed with a surgical procedure called arthroplasty, mild to moderate disease is typically managed with lifestyle modification, NSAIDS (such as ibuprofen) and joint injections. A large number of individuals have mild to moderate disease with inadequately controlled pain using traditional methods yet do not qualify for joint replacement. Geniculate artery embolization is a promising treatment option to bridge this gap and provide durable pain control in patients with mild to moderate osteoarthritis.

Any patient with mild to moderate osteoarthritis with uncontrolled pain using oral pain medications and/or joint injections may benefit from geniculate artery embolization.

To understand how geniculate artery embolization works, we need to understand that osteoarthritis and pain is shown by recent research to be much more complicated than previously thought. Pain development with osteoarthritis involves a feedback loop where pain is the result of low-level inflammation. The inflammation releases chemicals into the blood, which results in the formation of new blood vessels in the knee. The development of new blood vessels results in greater pain/inflammation and starts the cycle again. Studies have shown that the degree of new blood vessel formation (neoangiogenesis) has been directly linked to severity of pain.

Geniculate artery embolization works by using microscopic beads to block the formation of new blood vessels and break the feedback loop that leads to inflammation and pain. Research demonstrates significant improvement in pain after geniculate artery embolization, which continues to improve over at least 2 years. This allows patients to minimize the amount of pain medications and joint injections they need while optimizing quality of life.

Geniculate artery embolization has many benefits:

• It is effective, as is shown by the significant improvement in pain with durable improvement for at least 2 years.
• It is safe. There are no major adverse events and few minor adverse events.
• It is minimally invasive, which typically means a short recovery period when compared to surgical procedures.
• It can be provided on an outpatient basis, and you will go home to recover following geniculate artery embolization.
• It can be performed under moderate sedation.
• It is well-tolerated by patients.

Geniculate artery embolization has a few risks to consider:

• This type of nontarget embolization can result in temporary skin discoloration. This occurs in 10-65% of patients.
• Patients may have a puncture site hematoma. This occurs in 10-17% of patients.
• Other minor complications are very rare, including plantar paresthesias (often described as a tingling), bone infarction (damage to bone tissue) and postembolization syndrome (a short-term period of fever, nausea and other symptoms).

What happens during geniculate artery embolization?

• Prior to the treatment, you will meet with an interventional radiologist to discuss your symptoms, review imaging and determine a treatment plan.
• The procedure is performed as an outpatient, which means you will not need to spend the night in the hospital.
• You will first be given a combination of medications through an IV to provide sedation and keep you comfortable during the procedure. Because geniculate artery embolization is minimally invasive and well-tolerated, general anesthesia is not needed.
• Next, a tiny incision will be made and a catheter (thin tube) will be placed into an artery in your groin.
• X-ray will be used to guide catheters into the arteries that supply the knee inflammation and show neovascularity (new blood vessels). Once the catheter is in position, small beads will be injected to block the arteries and break the cycle of inflammation.
• The devices will be removed after the beads are injected and a plug will be used to close the opening in the groin artery. The entire process takes 1-2 hours to perform.
• You will be observed for a short period of time after the procedure and then be discharged home.
• You will be limited to nonstrenuous activity and no heavy lifting for 7-10 days after the procedure. Most people are able to resume normal activities the same day.

Interventional radiologists, including those who specialize in vascular, neurologic and cancer conditions, at The University of Kansas Health System provide therapeutic and diagnostic procedures for conditions affecting every area of the body. Our nationally recognized team of interventional radiologists has been ranked in the top 1% of hospitals nationwide in patient volume by Vizient®, the nation’s largest member-driven healthcare performance improvement organization.

As part of a major academic center, we work with the University of Kansas Medical Center to be on the leading edge of developing treatments such as geniculate artery embolization and offer physicians with unique skill sets to perform them effectively. We strive to provide the highest quality of care to every patient and believe that geniculate artery embolization can offer millions of people a low-risk treatment that dramatically improves their quality of life.

• By KUMC physician: Outpatient referral to interventional radiology.
• Self-referral: request an appointment.
• By outside physician:
• Fax a request to interventional radiology schedulers at 913-588-8376.
• Or call interventional radiology scheduling at 913-588-1030.