Angiographic Analysis of the Anatomical Variants in Genicular Artery Embolization

Abstract

Purpose: Genicular artery embolization (GAE) has been proposed as a novel technique to treat painful synovitis related to osteoarthritis. An in-depth understanding of the genicular arterial anatomy is crucial to achieve technical success and avoid nontarget-related complications. Given the lack of previous angiographic description, the present study analyzes genicular arterial anatomy and proposes an angiographic classification system. Materials and Methods: Angiographic findings from 41 GAEs performed during two US clinical trials from January 2017 to July 2019 were reviewed to analyze the anatomical details of the following vessels: descending genicular artery (DGA), medial superior genicular artery (MSGA), medial inferior genicular artery (MIGA), lateral superior genicular artery (LSGA), lateral inferior genicular artery (LIGA), and anterior tibial recurrent artery (ATRA). The diameter, angle of origin, and anastomotic pathways were recorded for each vessel. The branching patterns were classified as: medially, M1 (3/3 arteries present) vs M2 (2/3 arteries present); and laterally, L1 (3/3 arteries present) vs L2 (2/3 arteries present). Results: A total of 91 genicular arteries were embolized: DGA (26.4%), MIGA (23.1%), MSGA (22.0%), LIGA (14.3%), and LSGA/ATRA (14.3%). The branching patterns were: medially = M1, 74.4% (n = 29), M2, 25.6% (n = 10); and laterally = L1, 94.9% (n = 37), L2, 5.1% (n = 2). A common origin for MSGA and LSGA was noted in 11 patients (28.2%). A direct DGA origin from the popliteal artery was reported in three patients (7.7%, n = 3). Conclusions: A thorough understanding of the geniculate arterial anatomy is important for maximizing postprocedural pain reduction while minimizing complications, procedure time, and radiation exposure during GAE.

Emerging Targets for the Treatment of Osteoarthritis: New Investigational Methods to Identify Neo-Vessels as Possible Targets for Embolization

“…GAE requires a fundamental knowledge of knee vascular anatomy, along with its variations, for effectively and safely identifying the embolizing target [ 37 , 38 ]. Three main vessels provide the vascular supply to the knee.…”

“…Angiographic studies also correlate with these cadaveric findings. In a recent study by Bagla et al, angiographic findings from 39 GAE procedures showed anatomical variations of the medial and lateral genicular arteries [ 38 ]. Three medial branches (DGA, SMGA, and IMGA) and three lateral branches (SLGA, ILGA, and ATRA) were analyzed.…”

“…For the lateral knee, the presence of all three lateral branches was classified as L1 while L2 was classified as the presence of two of the three. This provides a classification system clinically oriented toward consistent reporting for GAE and better predicting anastomotic networks [ 38 ].…”

Musculoskeletal Interventions: A Review on Genicular Artery Embolization

“…An angiographic classification for the genicular vascular anatomy was proposed recently: medially-M1 (3/3 arteries present) versus M2 (2/3 arteries present), laterally-L1 (3/3 arteries present) versus L2 (2/3 arteries present). 16 Of note, the superior patellar artery and the median genicular artery were studied by Okuno et al but has not been included in any other studies given its small vessel size and limited involvement in the knee joint. When performing GAE, it is important to understand that the knee joint is a highly vascular structure with numerous arterial anastomoses that can potentially lead to nontarget embolization.…”

A Review of Musculoskeletal Embolization to Treat Pain Outside of the Knee

“…6,7 This principle has been successfully applied to knee pain secondary to osteoarthritis (OA), as genicular artery embolization (GAE) was found to significantly reduce pain and increase function in patients with mild to moderate OA. [8][9][10][11][12][13][14][15][16] The success of GAE for OA has led to the application of musculoskeletal embolization to other inflammatory conditions like adhesive capsulitis (AC), lateral epicondylitis (LE), and other isolated cases of tendinitis.…”