![[Genicular Artery Embolization A Review of Essential Anatomic Considerations.pdf]] ### Background - No treatment - Medical management - Joint injections - Replacement Standard of care hasn’t changed in 30 years Stem cells, PRP, laser Poor studies, short term follow up AAOS Guidelines and ACR (Rheumatology) don’t have any other good options ### Pathophysiology - Inflammation - Elevated cytokines - Synovitis causes it all ![[IMG_3494.jpeg]] FDA won’t grant approval for any single arm trial Comparative RCTs will be required Patients feel great after GRAVITY Study: 100 patients vs observation ### Anatomy ![[image 2.jpg]] Medal first branch. Has 3 branches Superior medial and lateral genixular arteries from behind the knee goes around the fenoral condules ![[image 3.jpg]] ![[image 4.jpg]] ![[image 5.jpg]] Don’t confuse this with other popliteal muscle and nerve branches ![[image 6.jpg]] Horizontal branch that wraps around all the tibia ![[image 7.jpg]] Anterior recurrent ![[image 8.jpg]] Supplies the crucial ligament ### Technique - Gentle embolization, remove the extra blush - Mark the site of pain with a bb - Come beam CT ![[image 9.jpg]] - Access antegrade ipsilateral CFA - 2.0 Fr or smaller microcathater - Perpendicular branch to the skin is a cutaneous branch - 100-200 mcg nitro before embolization - This might reproduce the pain - Ice on the skin if needed, wait a few mins - 0.4 mL of dilute (10:5) contrast:saline 100 um particles - On dischagre - 500 mg naproxen BID x 5 days - Metro dose pack ### Technique 2 - Cone beam CT - Improved safety - From distal SFA - Find BB and work back - Or from individual arteries - 0.3 mL/s 6 s delay for 6 mL? ### Outcomes - Yuji Okuno, MD - 70% dramatic reduction in pain in first 3 months - Meta analysis paper - Saftey - Cutaneous damage Peripheral neuopathy Post embo ischemic pain Meniscus tears respond poorly (but not horizontal tears) Subchondr insufficieny fractures of the knee respond poorly Permanent spheres are batter most likely Durability: high? Code: 37242 (not an organ) Pain reduction is not immmediate. May get worse at first. Need to wait up to 3 months. If not improvement at 3 months it likely failed. Them could offer nerve ablation.