Genicular Artery Embolization (GAE)

The GAE Procedure

Pre-Procedure Preparation

a. Patient Evaluation The success of GAE begins with careful patient selection.

• Medical History: Physicians review the patient’s medical background, focusing on knee pain duration, previous treatments, and underlying conditions.
• Imaging Studies: MRI, CT scans, or X-rays are conducted to assess the extent of osteoarthritis and identify inflammation hotspots.
• Eligibility Criteria: Ideal candidates typically have moderate to severe knee pain resistant to conservative treatments but do not exhibit significant joint deformities or advanced osteoarthritis requiring surgery.

b. Patient Education Patients are briefed on what to expect during and after the procedure. They are informed about potential risks, benefits, and the overall recovery process.

c. Pre-Procedure Guidelines

• Fasting: Patients are advised to refrain from eating or drinking for 6-8 hours before the procedure.
• Medications: Blood-thinning medications may need to be paused to minimize bleeding risks. Patients should consult their physician about all current medications.

a. Setting Up GAE is performed in a sterile interventional radiology suite equipped with advanced imaging technology. The procedure typically takes 1-2 hours and is conducted under local anesthesia with mild sedation to ensure patient comfort.

b. Arterial Access

• Incision Point: A small puncture is made, usually in the groin (femoral artery) or wrist (radial artery), to insert a thin catheter into the arterial system.
• Catheter Placement: Using fluoroscopic guidance, the interventional radiologist carefully advances the catheter toward the genicular arteries supplying the inflamed areas of the knee.

c. Identification of Target Vessels

• Contrast Dye Injection: A contrast agent is injected to visualize the blood vessels on imaging and pinpoint the abnormal vessels contributing to inflammation.
• Mapping: The interventional radiologist identifies the specific genicular arteries requiring embolization.

d. Embolization Process

• Embolic Agent Selection: Tiny particles, such as microspheres or polyvinyl alcohol (PVA) particles, are chosen for their ability to safely block blood flow to the target area.
• Injection: The embolic agent is carefully delivered into the identified vessels, causing them to occlude and cut off the blood supply to the inflamed synovium.
• Verification: Post-embolization imaging confirms successful occlusion of the targeted vessels and ensures no unintended blockage of healthy vessels.

e. Final Steps

• Catheter Removal: The catheter is gently removed, and pressure is applied to the access site to prevent bleeding.
• Bandaging: The incision site is bandaged, and patients are monitored briefly before discharge.

Post-Procedure Care

a. Immediate Recovery

• Observation Period: Patients remain under observation for 1-2 hours to monitor vital signs and ensure there are no immediate complications.
• Discomfort Management: Mild pain or bruising at the insertion site is common and can be managed with over-the-counter pain relievers.

b. Home Care Instructions

• Activity Levels: Patients are advised to avoid strenuous activities for 24-48 hours but can generally resume normal activities shortly after.
• Incision Care: Keeping the bandage dry and clean is crucial to prevent infection.

c. Follow-Up Regular follow-up appointments are scheduled to evaluate the patient’s response to the procedure. Pain relief is often noticeable within a few weeks, with significant improvements seen in 1-3 months.