The Impact of Geniculate Artery Collateral Circulation on Lower Limb Salvage Rates in Injured Patients

Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain

Osteoarthritis (OA) of the knee is a prevalent cause of chronic pain and disability, particularly affecting women. While traditionally attributed to chronic wear and tear, recent evidence highlights multifactorial pathogenesis involving low-grade inflammation and neoangiogenesis. Current therapeutic options include physical therapy, pharmacotherapy, and total knee arthroplasty (TKA). However, a subset of patients remain symptomatic despite conservative measures, necessitating the development of minimally invasive interventions. Genicular artery embolization (GAE) emerges as a promising option, targeting neovascularization and inflammatory processes in OA. This paper reviews the pathophysiological basis, patient selection criteria, procedural details, and outcomes of GAE. Notably, GAE demonstrates efficacy in relieving knee pain and improving function in patients refractory to conventional therapy. While further research is warranted to elucidate its long-term outcomes and compare it with existing modalities, GAE represents a novel approach in the management of symptomatic knee OA, potentially delaying or obviating the need for surgical intervention. Here, we synthesize the relevant literature, technical details of the procedure, and future perspectives. Moreover, the success of GAE prompts the exploration of transarterial embolization in other musculoskeletal conditions, underscoring the evolving role of interventional radiology in personalized pain management strategies.

Controversial case: Revascularization of a popliteal vascular injury of poor prognosis

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We need to revaluate and modify our current amputation prediction scores.

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More than 6 h of ischemia does not translate to a bad prognosis.

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There are multiple variables that affect the evolution of the patient.

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It is important to consider revascularization especially in all young patients without significant concomitant injuries and lack of comorbidities.

Introduction

Popliteal injuries are significant health risk that could induce permanent functional impairment, limb loss, and in some cases death. Currently, there is a controversy about the required treatment between amputation and a limb salvage surgery, which in some cases could cause more prominent functional impairment than the amputation. Different indicators help to predict, in some extent, the risk of amputation, however most of them were described two decades ago.

Presentation of case

A patient with a prolonged hot ischemia and in critical conditions, which had no favorable clinical indicators for revascularization is shown and discussed. By means of intraoperative analysis, it was decided to perform a revascularization for limb salvage, progressing with a positive outcome.

Discussion

Advancements in medical and vascular surgery, such as osteovascularized grafts, the use of flaps to cover large defects, the Ilizarov method for bone elongation and stabilization, the use of growth factors, negative pressure therapy, and the use of extracellular matrix, the improvements of intensive care units (ICU), among others, make necessary to revisit and reevaluate these indicators. The accuracy of these indicators has dropped significantly, and currently the medical evaluation cannot longer only depend on them.

Conclusion

Our results suggest the need to revisit and improve the predicting indicators scores for amputation prognosis that should include a preoperative and transoperative analysis.