Advertisement

Genicular Artery Embolisation Data Review-reviewing the Current Data for the Embolisation Treatment of Knee Osteoarthritis and Highlighting Areas Requiring Further Evidence

Published:December 21, 2022DOI:https://doi.org/10.1016/j.tvir.2022.100880
      Osteoarthritis of the knee poses an ever-expanding healthcare challenge worldwide. Current treatments include conservative methods such as weight loss, pharmacological treatments including NSAIDs, and surgical techniques including total knee arthroplasty. Although frequently successful, contraindications and failure of pharmacological agents leave many, especially with mild-moderate disease, without effective treatment. Genicular artery embolization is an interventional radiology technique being developed to fill this treatment gap. For this procedure to become established, the literature must provide evidence of its underlying scientific principles, safety, efficacy and economic viability. Pathological investigation of osteoarthritis reveals that low-level inflammation plays a crucial role in disease development. Joint inflammation stimulates neoangiogenesis and accompanying neuronal growth, with the degree of microvascular invasion being correlated with more severe pain in animal models. These neovessels provide a target for embolization however, the microscopic effects of this intervention are yet to be elucidated. The side effects of GAE have been extensively investigated with no severe adverse events being recorded. Skin discoloration and puncture site hematoma are the most common, occurring in 10%-65% and 0%-17% of patients respectively. The literature also discusses ways to minimize these events. Phase one studies provide promising evidence of efficacy, demonstrating an 80% improvement in Visual Analogue Scale (VAS) and a mean difference of 36.8 in Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at 24-months. These positive signals are also supported by a single randomized control trial. A single study has been completed regarding the cost of GAE, however further work is needed. The GAE literature demonstrates a safe procedure with promising initial evidence of efficacy. Future work should further elucidate the pathology of osteoarthritis and ways in which embolization modifies this process, alongside providing further randomized control evidence that aligns with the recommendations from the National Institute for Health and Care Excellence. The future of GAE is exciting!

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Techniques in Vascular & Interventional Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Radin E.L.
        • Paul I.L.
        • Rose R.M.
        Role of mechanical factors in pathogenesis of primary osteoarthritis.
        Lancet. 1972; 1: 519-522https://doi.org/10.1016/s0140-6736(72)90179-1
        • Talaie R.
        • Torkian P.
        • Clayton A.
        • et al.
        Emerging targets for the treatment of osteoarthritis: new investigational methods to identify neo-vessels as possible targets for embolization.
        Diagnostics. 2022; 12: 1403https://doi.org/10.3390/diagnostics12061403
        • Mapp P.I.
        • Walsh D.A.
        Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis.
        Nat. Rev. Rheumatol. 2012; 8: 390-398https://doi.org/10.1038/nrrheum.2012.80
        • Ashraf S.
        • Walsh D.A.
        Angiogenesis in osteoarthritis.
        Curr Opin Rheumatol. 2008; 20: 573-580https://doi.org/10.1097/BOR.0b013e3283103d12
        • Bonnet CS
        • Walsh DA.
        Osteoarthritis, angiogenesis and inflammation.
        Rheumatology (Oxford). 2005; 44: 7-16https://doi.org/10.1093/rheumatology/keh344
        • Korchi A.M.
        • Cengarle-Samak A.
        • Okuno Y.
        • et al.
        Inflammation and hypervascularization in a large animal model of knee osteoarthritis: imaging with pathohistologic correlation.
        J Vasc Interv Radiol. 2019; 30: 1116-1127https://doi.org/10.1016/j.jvir.2018.09.031
        • Horng A
        • Stroebel J
        • Geith T
        • et al.
        Multiscale X-ray phase contrast imaging of human cartilage for investigating osteoarthritis formation.
        J Biomed Sci. 2021; 28: 42https://doi.org/10.1186/s12929-021-00739-1
        • Uflacker A.B.
        • Keefe N.
        • Bruner E.T.
        • et al.
        Assessing the effects of geniculate artery embolization in a nonsurgical animal model of osteoarthritis.
        J Vasc Interv Radiol. 2022; 33: 1073-1082https://doi.org/10.1016/j.jvir.2022.05.015
        • de Sousa Valente J.
        The pharmacology of pain associated with the monoiodoacetate model of osteoarthritis.
        Front Pharmacol. 2019; 10: 974https://doi.org/10.3389/fphar.2019.00974
        • Casadaban L.C.
        • Mandell J.C.
        • Epelboym Y.
        Genicular artery embolization for osteoarthritis related knee pain: a systematic review and qualitative analysis of clinical outcomes.
        Cardiovasc Intervent. Radiol. 2021; 44: 1-9https://doi.org/10.1007/s00270-020-02687-z
        • Padia S.
        • Plotnik A.
        • Blumstein G
        • et al.
        Abstract No. 16 Genicular artery embolization for the treatment of knee osteoarthritis: final results from a prospective investigational device exemption trial.
        J Vasc Interv Radiol. 2021; 32: S8https://doi.org/10.1016/j.jvir.2021.03.429
        • Okuno Y.
        • Korchi A.M.
        • Shinjo T.
        • Kato S.
        • Kaneko T.
        Midterm clinical outcomes and mr imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment.
        J Vasc Interv Radiol. 2017; 28: 995-1002https://doi.org/10.1016/j.jvir.2017.02.033
        • Spies JB
        • Berlin L.
        Complications of femoral artery puncture. 170. American Roentgen Ray Society, Leesburg, VA1998: 9-11https://doi.org/10.2214/ajr.170.1.9423587
        • Chen HZ
        • Liang WS
        • Yao WF
        • Liu TX.
        Compression methods after femoral artery puncture: a protocol for systematic review and network meta-analysis.
        Medicine. 2021; 100: e24506https://doi.org/10.1097/MD.0000000000024506
        • Torkian P.
        • Golzarian J.
        • Chalian M.
        • et al.
        Osteoarthritis-related knee pain treated with genicular artery embolization: a systematic review and meta-analysis.
        Orthop J Sports Med. 2021; 923259671211021356https://doi.org/10.1177/23259671211021356
        • Padia SA
        • Genshaft S
        • Blumstein G
        • et al.
        Genicular artery embolization for the treatment of symptomatic knee osteoarthritis.
        JB JS Open Access;. 2021; 6https://doi.org/10.2106/JBJS.OA.21.00085
        • Lee SH
        • Hwang JH
        • Kim DH
        • et al.
        Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: mild-to-moderate versus severe knee osteoarthritis.
        Cardiovasc. Intervent. Radiol. 2019; 42: 1530-1536https://doi.org/10.1007/s00270-019-02289-4
        • Bagla S
        • Piechowiak R
        • Hartman T
        • Orlando J
        • Del Gaizo D
        • Isaacson A.
        Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis.
        J Vasc Interv Radiol. 2020; 31: 1096-1102https://doi.org/10.1016/j.jvir.2019.09.018
        • O'Grady A
        • Welsh L
        • Gibson M
        • Briggs J
        • Speirs A
        • Little M.
        Cadaveric and angiographic anatomical considerations in the genicular arterial system: implications for genicular artery embolisation in patients with knee osteoarthritis.
        Cardiovasc Intervent Radiol. 2021; 45: 80-90https://doi.org/10.1007/s00270-021-02978-z
        • Parvizi D.
        • Vasilyeva A.
        • Wurzer P.
        • et al.
        Anatomy of the vascularized lateral femoral condyle flap.
        Plast Reconstr Surg. 2016; 137: 1024e-1032ehttps://doi.org/10.1097/PRS.0000000000002182
        • Little M.W.
        • Gibson M.
        • Briggs J.
        • et al.
        Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) using permanent microspheres: interim analysis.
        Cardiovasc Interv Radiol. 2021; 44: 931-940https://doi.org/10.1007/s00270-020-02764-3
        • Hindsø L
        • Riis RGC
        • Hölmich P
        • et al.
        Current status of trans-arterial embolization in pain management of musculoskeletal inflammatory conditions — an evidence-based review.
        Cardiovasc Interv Radiol. 2021; 44: 1699-1708https://doi.org/10.1007/s00270-021-02948-5
        • Bagla S.
        • Piechowiak R.
        • Hartman T.
        • Orlando J.
        • Lipscomb M.
        • Benefield T.
        • Isaacson A:
        Multicenter prospective, randomized, sham-controlled study of genicular artery embolization.
        J Vasc Interv Radiol. 2020; 31: S6https://doi.org/10.1016/j.jvir.2019.12.023
        • Sajan A.
        • Mehta T.
        • Griepp D.W.
        • Chait A.R.
        • Isaacson A.
        • Bagla S.
        Comparison of minimally invasive procedures to treat knee pain secondary to osteoarthritis: a systematic review and meta-analysis.
        Journal of Vascular and Interventional Radiology. 2022; 33: 238-248https://doi.org/10.1016/j.jvir.2021.11.004
        • Davies E
        • Isaacson A.
        3:27 PM Abstract No. 204 Cost analysis of geniculate artery embolization versus conservative therapy for pain secondary to knee osteoarthritis.
        J Vasc Interv Radiol. 2018; 29: S89
        • Harrison R.
        • Salomons T.V.
        • Gandhi W.
        • MacGill S.
        • McLaren C.
        • Little M:
        The role of pain catastrophising in osteoarthritic knee pain following genicular arterial embolisation.
        British Pain Society Annual General Meeting. 2022;
      1. National Institute for Health and Care Research. Recommendations | Genicular artery embolisation for pain from knee osteoarthritis. NICE; Available at: https://www.nice.org.uk/guidance/ipg708/chapter/1-reccomendations.