GAE

GAE is a new minimally invasive procedure indicated for refractory arthritic knee pain.
Indicated for patients who have tried some conservative approaches for knee pain such as weight loss, physical therapy, pain medication, and steroid or other injections without success.
It's best for patients that have mild to moderate knee arthritis with significant pain who are not candidates for or don't desire knee replacement surgery.

GAE provides patients with an alternative treatment for their knee pain.

How the procedure works:

• There is a cycle of inflammation and cartilage loss in the knee joint and in this process new abnormal blood vessels are formed in the synovium (or the lining of the knee joint) of which contributes to inflammation and subsequent pain.
• The GAE procedure targets these new abnormal blood vessels to reduce inflammation in the knee which leads to pain relief and improved function

The procedure:

• Procedure is done in the outpatient setting, takes 1-2 hours to complete with same day discharge.
• The procedure is not painful but is done under conscious sedation for comfort.
• We access the femoral artery (top of the leg) with a small catheter and perform a diagnostic angiogram of the knee.
• The geniculate arteries are evaluated and branches contributing to knee inflammation are targeted for embolization.
• Embolization is gentle and only done to prune the hyperemic vascularity while the parent vessel remains patent (see picture below).
• If the patient's pain is localized to a specific part of the knee, those genicular arteries are targeted to maximize pain relief.
• It has been proven to be a safe procedure, and major complications are very rare (<1%).
• Recover time is short, we instruct patients to take it easy for a couple days with no strenuous lifting or activity but then return to regular activity after that.
• Relief of pain is a gradual process after the procedure that usually takes 2-3 weeks for the full affect as the knee will experience significantly less inflammation

Results

Summary

Example of GAE. A) Initial angiogram of a medial geniculate artery with prominent synovial blush contributing to inflammation and pain. B) After gentle embolization, the synovial blush is gone but the main artery remains open. 

Little et al. https://pubmed.ncbi.nlm.nih.gov/33474601/