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Dablan A, Erdim Ç, Güzelbey T, Cingöz M, Arslan MF, Mutlu İN, Kılıçkesmez Ö. Effectiveness of Genicular Artery Embolization for Reducing Synovitis as Assessed by Contrast-Enhanced MR Imaging in Knee Osteoarthritis: A Pilot Study. J Vasc Interv Radiol 2024; 35:1313-1322.e6. [PMID: 38871259 DOI: 10.1016/j.jvir.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/08/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To investigate the impact of genicular artery embolization (GAE) on synovitis in knee osteoarthritis (OA) using contrast-enhanced magnetic resonance (MR) imaging and to assess its predictive role in pain response. MATERIALS AND METHODS A single-center retrospective analysis was conducted using contrast-enhanced MR imaging on 33 patients treated with GAE for knee OA between December 2022 and March 2023. MR assessments before the procedure and at 3 months after embolization were utilized in a semiquantitative scoring system for synovitis severity and distribution analysis. Pain and function through Western Ontario and McMaster Universities Osteoarthritis Index and visual analog scale scores were also assessed. RESULTS Significant synovitis reduction was noted after GAE, particularly in parapatellar and periligamentous areas. Synovial contrast enhancement scores significantly decreased from 5.1 (SD ± 2.0) to 2.9 (SD ± 2.0) at 3 months (P < .001), with a moderate negative correlation between synovial enhancement scores and pain levels (P = .005). CONCLUSIONS GAE significantly reduced synovitis in knee OA, evidenced by contrast-enhanced MR imaging. The correlation between preprocedural synovial contrast enhancement scores and pain relief after the procedure, although promising, requires careful interpretation because of the complex factors affecting pain in knee OA.
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Affiliation(s)
- Ali Dablan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey.
| | - Çağrı Erdim
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| | - Tevfik Güzelbey
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| | - Mehmet Cingöz
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| | - Mustafa Fatih Arslan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| | - İlhan Nahit Mutlu
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| | - Özgür Kılıçkesmez
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
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Kubo T, Shibuya M, Miyazaki K, Tsuji Y, Nakata M, Kawabe A, Nakasone T, Sakai N, Okuno Y. Transcatheter Arterial Embolization for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Retrospective Study of 44 Patients. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03842-6. [PMID: 39191997 DOI: 10.1007/s00270-024-03842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To investigate the preliminary treatment outcomes of transcatheter arterial embolization (TAE) for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS This retrospective study included patients with refractory CP/CPPS who underwent TAE between April 2022 and February 2023. All patients had persistent pelvic pain for at least 3 months, a total score of at least 15 on the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI), and lacked evidence of infection. All procedures were performed by injecting imipenem/cilastatin sodium (IPM/CS) from bilateral prostatic arteries ± internal pudendal arteries. NIH-CPSI, pain numeric rating scale (NRS), and complications were evaluated at 1, 3, and 6 months after the initial TAE and at the final follow-up. RESULTS Out of 48 patients, 44 were included in this study, with four excluded because of loss of follow-up. No severe procedure-related complications were observed. Pretreatment and post-treatment evaluations at 1, 3, and 6 months after the initial TAE and at the final follow-up (mean 16.6 months) revealed a decrease in the mean NIH-CPSI scores from 27 ± 6 to 21 ± 8, 20 ± 9, 17 ± 9, and 18 ± 9, respectively (all P < 0.001). Pain NRS scores were also decreased from 7.0 ± 1.6 to 4.8 ± 2.5, 4.1 ± 2.6, 3.7 ± 2.4, and 3.4 ± 2.3, respectively (all P < 0.001). The proportions of clinical success, defined as a reduction of at least 6 points from baseline in the NIH-CPSI, at 6 months after TAE and at the final follow-up were 70 and 64%, respectively. CONCLUSIONS This study provides evidence of the feasibility of TAE using IPM/CS for CP/CPPS, suggesting both symptomatic improvement and safety.
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Affiliation(s)
- Takatoshi Kubo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Masahiko Shibuya
- Department of Interventional Radiology, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-Ku, Kobe City, Hyogo, 650-0021, Japan
| | - Koichi Miyazaki
- Department of Interventional Radiology, Okuno Clinic Osaka, 3Rd Fl Shinsaibashi Front Bldg., 3-5-11, Minamifunaba, Chuo-Ku, Osaka, 542-0081, Japan
| | - Yusuke Tsuji
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Masaya Nakata
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Atsuhiko Kawabe
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Takashi Nakasone
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Nobuaki Sakai
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan
| | - Yuji Okuno
- Department of Interventional Radiology, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-Ku, Tokyo, 106-0032, Japan.
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Padia SA, Genshaft SJ. Genicular Artery Embolization: Tried-and-True Femoral Access Still Works Best. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03806-w. [PMID: 39187652 DOI: 10.1007/s00270-024-03806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095, USA.
| | - Scott J Genshaft
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095, USA
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Berreta RS, Rubin J, Manivannan A, Jackson G, Cotter E, Kahn Z, McCormick J, Villarreal-Espinosa JB, Ayala S, Verma NN, Chahla J. Geniculate Artery Embolization for the Treatment of Mild to Moderate Knee Osteoarthritis Improves Pain and Function: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00567-X. [PMID: 39159728 DOI: 10.1016/j.arthro.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 07/11/2024] [Accepted: 07/27/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE To evaluate procedural heterogeneity, patient reported outcomes (PRO), and complications following geniculate artery embolization (GAE) for knee OA. METHODS A literature search was performed using PubMed, Embase, and Scopus databases from inception to August 2023 according to the 2020 PRISMA guidelines. Human clinical studies reporting PROs following GAE for treatment of knee OA were included and a qualitative comparison across PROs, procedural descriptions and complications was performed. Study quality was assessed using the Cochrane Collaboration's risk of bias tool and the MINORS criteria. The primary outcome measures included changes in PROs at 12 months and variances in procedural methodology. RESULTS A total of 17 studies, consisting of 533 patients and 620 knees were identified. The reported mean improvement at 12 months for VAS pain and WOMAC scores ranged from 10-59 and 35.3-47, respectively. At 12 months, median improvements were observed in KOOS subscales such as Pain (range, 8.3-19.5), QOL (15.49-25.0), Sport (7.5-26.3) and Symptoms (1.8-25.0). Decreasing MCID achievement was observed between the 3 month and 6 month follow-up points. Patients with advanced OA and degenerative findings on MRI exhibited lower rates of MCID achievement. Transient adverse events occurred in up to 80% of patients. Limited evidence from serial MRI assessments suggests that GAE improves levels of synovitis. Significant heterogeneity exists among the GAE methodology as 4 different definitions of technical success, 4 distinct embolization targets and use of 5 embolization agents were noted. CONCLUSION GAE results in short-term improvements in pain and function with decreasing MCID achievement observed after 3 to 6 months. Patients with severe OA also demonstrate lower rates of MCID achievement. A high rate of transient complications are reported including skin discoloration and access site hematomas. Significant protocol heterogeneity exists which contributes to variable outcomes. LEVEL OF EVIDENCE IV; Systematic Review of Level IV Studies.
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Affiliation(s)
| | - Jared Rubin
- University of Illinois College of Medicine, Chicago, IL
| | | | - Garret Jackson
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | - Eric Cotter
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | - Zeeshan Kahn
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | | | | | - Salvador Ayala
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | - Nikhil N Verma
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL
| | - Jorge Chahla
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL.
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Ciaffi J, Papalexis N, Vanni E, Miceli M, Faldini C, Scotti L, Zambon A, Salvarani C, Caporali R, Facchini G, Ursini F. Minimally invasive interventional procedures for osteoarthritis and inflammatory arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2024; 68:152525. [PMID: 39137511 DOI: 10.1016/j.semarthrit.2024.152525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE to summarize the evidence on the efficacy of minimally invasive interventional procedures such as radiofrequency ablation (RFA) and transcatheter arterial embolization (TAE) in patients with osteoarthritis or inflammatory arthritis. METHODS a literature search was conducted in PubMed and Web of Science databases. Both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) were included. The results were organized according to the treated anatomical site: knee, hip, foot and ankle, shoulder, hand and wrist, sacroiliac joints. Data about treatment efficacy were extracted. The main outcome was change in pain intensity using the 0-10 visual analog scale (VAS) from baseline to 1 month. Additional timepoints at 3, 6 and 12 months were assessed. Change in functional status was evaluated. Pooled estimates were calculated as the mean difference (MD) and 95 % confidence interval relative to baseline. The meta-analyses of RCTs and NRSI were conducted separately. RESULTS of the 4599 retrieved articles, 164 were included in the review and, considering all the established timepoints, 111 (38 RCTs and 73 NRSI) were selected for the meta-analysis. Only one article described patients with inflammatory arthritis. In the meta-analysis of RCTs, one month after the procedure, MD in VAS was -3.98 (-4.41 to -3.55; k = 21) for knee RFA, and -3.18 (-3.96 to -2.39; k = 8) for sacroiliac joints RFA. In the meta-analysis of NRSI, MD in VAS was -4.12 (-4.63 to -3.61; k = 23) for knee RFA, -3.84 (-4.77 to -2.92; k = 7) for knee TAE, -4.34 (-4.96 to -3.71; k = 2) for hip RFA, -3.83 (-4.52 to -3.15; k = 3) for shoulder RFA and -4.93 (-5.58 to -4.28; k = 14) for sacroiliac joints RFA. Significant decrease in pain intensity was found also at 3, 6 and 12 months. Additionally, functional status improved at all the assessed timepoints. CONCLUSION minimally invasive interventional procedures can improve pain and functional status of patients affected by OA or chronic sacroiliac pain of degenerative origin. Further research is warranted in the field of inflammatory rheumatic diseases.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy.
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Vanni
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carlo Salvarani
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan and ASST G. Pini-CTO, Milan, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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Guzelbey T, Dablan A, Arslan MF, Altun O, Mutlu IN, Kılıckesmez O. Comparing technical success and clinical outcomes of macrocatheter versus microcatheter in genicular artery embolization for knee osteoarthritis. Eur J Radiol 2024; 177:111582. [PMID: 38897050 DOI: 10.1016/j.ejrad.2024.111582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the comparative effectiveness and safety of using macrocatheters versus microcatheters for genicular artery embolization (GAE) in the management of knee osteoarthritis (OA). The primary outcomes were technical success and adverse events during and immediately after the procedure. The secondary outcome was the clinical outcome over the follow-up period. MATERIALS AND METHODS In our retrospective analysis, we included 79 patients undergoing GAE for OA. Patients were categorized based on the catheter type used: microcatheter through macrocatheter or directly through macrocatheter. Key parameters, including technical success, adverse events, procedure duration, radiation exposure, and clinical outcomes (VAS and WOMAC scores), were assessed at 1st, 3rd, and 6th-month intervals. RESULTS Technical success stood at 100 % for the microcatheter group, with a slight reduction for the macrocatheter group at 91 % (p = 0.069). Procedure and fluoroscopy durations were significantly shorter in the macrocatheter group (p < 0.001). Additionally, the macrocatheter group demonstrated a marked reduction in radiation dose, with notably decreased air kerma values. Clinical outcomes, including VAS and WOMAC scores at the predefined intervals, revealed no significant disparities between the two cohorts. CONCLUSION In GAE procedures utilizing a temporary embolic agent (imipenem/cilastatin), initiating the intervention with a macrocatheter can be deemed cost-effective, safe and advantageous for patients with less complex vascular anatomy, as it significantly reduces procedural and fluoroscopy times, thereby minimizing radiation exposure. Conversely, in patients with intricate vascular pathways, transitioning to a microcatheter enhances technical success.
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Affiliation(s)
- Tevfik Guzelbey
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
| | - Ali Dablan
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
| | - Mustafa Fatih Arslan
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
| | - Omer Altun
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
| | - Ilhan Nahit Mutlu
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
| | - Ozgur Kılıckesmez
- Department of Interventional Radiology, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey.
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Ahmed O, Epelboym Y, Haskal ZJ, Okuno Y, Taslakian B, Sapoval M, Nikolic B, Golzarian J, Gaba RC, Little M, Isaacson A, Padia SA, Sze DY. Society of Interventional Radiology Research Reporting Standards for Genicular Artery Embolization. J Vasc Interv Radiol 2024; 35:1097-1103. [PMID: 38685470 DOI: 10.1016/j.jvir.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
Genicular artery embolization (GAE) is an emerging, minimally invasive therapy to address the global burden of knee osteoarthritis (OA) and the unmet needs for medically refractory disease. Although total knee arthroplasty has been a standard intervention for severe cases, GAE is developing into a promising alternative, particularly for patients ineligible for or unwilling to undergo surgery. GAE targets the inflammatory cascade underlying OA pathophysiology by arresting neoangiogenesis and preventing pathological neoinnervation, offering potential pain relief. Although early studies have established safety and short-term effectiveness, ensuing studies are needed to validate long-term safety, durability, and comparative effectiveness and to optimize patient selection, embolic agent selection, and administration techniques. Standardized reporting guidelines are therefore essential to enhance transparency and reproducibility across clinical trials, facilitating data aggregation and comparison. This Society of Interventional Radiology (SIR)-endorsed reporting standards consensus document provides a framework to harmonize future research efforts and to improve the interpretation of outcomes.
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Affiliation(s)
- Osman Ahmed
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Chicago Medicine, Chicago, Illinois.
| | - Yan Epelboym
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ziv J Haskal
- Department of Radiology and Medical Imaging/Interventional Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic, Tokyo, Japan
| | - Bedros Taslakian
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Marc Sapoval
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, and Université Paris Cité, PARCC-INSERM Unité-970, Paris, France
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - Jafar Golzarian
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ron C Gaba
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Mark Little
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, England, United Kingdom
| | | | - Siddharth A Padia
- Department of Radiological Sciences, University of California Los Angeles Medical Center, Los Angeles, California
| | - Daniel Y Sze
- Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California
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Hindsø L, Hölmich P, Petersen MM, Nielsen MB, Heerwagen S, Taudorf M, Lönn L. Transarterial Embolization of Geniculate Arteries Reduces Pain and Improves Physical Function in Knee Osteoarthritis-A Prospective Cohort Study. Diagnostics (Basel) 2024; 14:1627. [PMID: 39125502 PMCID: PMC11311436 DOI: 10.3390/diagnostics14151627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Knee osteoarthritis (OA) affects millions worldwide, leading to pain and reduced quality of life. Conventional treatments often fail to provide adequate relief, necessitating new therapeutic approaches. This study evaluated the efficacy and safety of genicular artery embolization (GAE) using permanent microspheres in patients with mild-to-moderate knee OA. In this prospective, single-center study, 17 participants underwent GAE. KOOS (Knee injury and Osteoarthritis Outcome Score), WOMAC (The Western Ontario and McMaster Universities Arthritis Index), and IPAQ (International Physical Activity Questionnaire) scores, along with physical performance tests, medication use, and dual-energy X-ray absorptiometry (DEXA) scans, were assessed at baseline and at multiple follow-up points over six months. The primary endpoint, VAS at six months, showed significant improvement (median reduction from 66 mm to 40 mm, p = 0.0004). All pain and function scores, as well as physical performance tests, improved significantly. No clinically relevant changes in medication use or DEXA parameters were observed after six months. Only minor, self-limiting adverse events occurred. This study indicates that GAE is a promising minimally invasive treatment for knee OA, providing significant pain relief and functional improvement. However, further long-term, randomized trials are needed to confirm these findings and establish optimal patient selection criteria.
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Affiliation(s)
- Louise Hindsø
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.B.N.); (S.H.); (M.T.); (L.L.)
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; (P.H.); (M.M.P.)
| | - Per Hölmich
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; (P.H.); (M.M.P.)
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Amager-Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark
| | - Michael M. Petersen
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; (P.H.); (M.M.P.)
- Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Michael B. Nielsen
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.B.N.); (S.H.); (M.T.); (L.L.)
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; (P.H.); (M.M.P.)
| | - Søren Heerwagen
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.B.N.); (S.H.); (M.T.); (L.L.)
| | - Mikkel Taudorf
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.B.N.); (S.H.); (M.T.); (L.L.)
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; (P.H.); (M.M.P.)
| | - Lars Lönn
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (M.B.N.); (S.H.); (M.T.); (L.L.)
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; (P.H.); (M.M.P.)
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Jeyaraman N, Migliorini F, Ramkumar V, Ramasubramanian S, Patro BP, Maffulli N, Jeyaraman M. Angioembolization in the management of joint pain: current concepts. ORTHOPADIE (HEIDELBERG, GERMANY) 2024:10.1007/s00132-024-04531-5. [PMID: 39060549 DOI: 10.1007/s00132-024-04531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Joint pain is a common complaint owing to its origin in inflammatory and degenerative joint diseases. Recent research has helped narrow down inadequate angiogenesis as one of the causes. Angioembolization has emerged as a treatment option for this condition when it is refractory to conservative treatment. This review describes angioembolization by elaborating on the mechanism, safety, efficacy, comparative analysis of treatment and the road ahead, in addition to summarizing the existing data on this treatment. The inferences from this review further consolidate transcatheter arterial embolization as one of the prime options for managing joint pain when it is refractory to conservative treatment and label it as one of the most exciting prospects. A limitation of this review is that most of the data were from open label case series or case reports.
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Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, 600077, Chennai, Tamil Nadu, India
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Bohler 5, 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Varunkumar Ramkumar
- Department of Orthopaedics, Madurai Medical College and Hospital, 625020, Madurai, Tamil Nadu, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, 600002, Chennai, Tamil Nadu, India
| | - Bishnu Prasad Patro
- Department of Orthopaedics, All India Institute of Medical Sciences, 751019, Bhubaneswar, Odisha, India
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Roma, Italy.
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, UK.
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, E1 4DG, London, UK.
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, 600077, Chennai, Tamil Nadu, India
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10
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Femia M, Valenti Pittino C, Fumarola EM, Tramarin M, Papa M, Giurazza F, Francioso AP, Fior D, Moramarco LP, Antonini G, Vercelli R, Cariati M. Genicular Artery Embolization: A New Tool for the Management of Refractory Osteoarthritis-Related Knee Pain. J Pers Med 2024; 14:686. [PMID: 39063940 PMCID: PMC11278466 DOI: 10.3390/jpm14070686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/25/2024] [Accepted: 06/09/2024] [Indexed: 07/28/2024] Open
Abstract
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.
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Affiliation(s)
- Marco Femia
- Interventional Radiology Unit, ASST Santi Paolo Carlo, 20122 Milan, Italy
| | | | | | - Marco Tramarin
- Interventional Radiology Unit, ASST Santi Paolo Carlo, 20122 Milan, Italy
| | - Maurizio Papa
- Complex Unit of Radiology, Department of Diagnostic, ASST Lodi, 26900 Lodi, Italy
| | - Francesco Giurazza
- Interventional Radiology Department, AORN “A. Cardarelli”, 80100 Naples, Italy
| | | | - Davide Fior
- Department of Radiology, Sant’Anna Hospital, ASST Lariana, 22100 Como, Italy
| | | | - Guido Antonini
- Department of Orthopedic and Traumatology, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, 20122 Milan, Italy
| | - Ruggero Vercelli
- Interventional Radiology Unit, ASST Santi Paolo Carlo, 20122 Milan, Italy
| | - Maurizio Cariati
- Interventional Radiology Unit, ASST Santi Paolo Carlo, 20122 Milan, Italy
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11
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Salm SAAA, Alzubaidi AHA, Leusink RJ. Genicular artery embolization for recurrent hemarthrosis: A case report. Radiol Case Rep 2024; 19:2337-2342. [PMID: 38532912 PMCID: PMC10963894 DOI: 10.1016/j.radcr.2024.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024] Open
Abstract
A 44-year-old otherwise healthy male with a history of trauma and surgical interventions in his right knee presented to the emergency department with repeated hemarthrosis of the right knee. The patient underwent blood tests, X-rays, and magnetic resonance imaging of the knee. A computed tomography angiography revealed blushing of the synovium of the knee. The patient underwent successful embolization of the genicular artery branches. Hemarthrosis did not recur. The use of genicular artery embolization, in our case, not only successfully addressed recurrent hemarthrosis but also underscores its emerging role in comprehensive patient management. This minimally invasive approach, precisely targeting the vascular supply to the affected synovium, offers an effective alternative where conventional therapies may fall short. Beyond symptom relief, it holds promise for preventing hemarthrosis recurrence, a valuable addition to clinicians' interventions for challenging knee joint bleeding cases. Further investigation in larger cohorts and comparative studies may reveal its broader applicability and long-term efficacy, shaping treatment options for recurrent hemarthrosis.
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Affiliation(s)
| | | | - Robert Johannes Leusink
- Department of Radiology, Vascular Interventional Section, Aalborg University Hospital, Aalborg, North Jutland, Denmark
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12
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Rouzbahani M, Husnain A, Badar W, Ahmed O. Genicular Artery Embolization: Embolic Material and Imaging Review. Semin Intervent Radiol 2024; 41:246-251. [PMID: 39165659 PMCID: PMC11333116 DOI: 10.1055/s-0044-1788029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Osteoarthritis (OA) of the knee is a degenerative condition impacting numerous individuals globally. Genicular artery embolization (GAE) has emerged as an effective minimally invasive therapy for managing medically refractory OA-related pain in patients who are not eligible for surgery. This intervention works by disrupting the inflammatory and neoangiogenic pathways that contribute to pain. The efficacy of GAE has been demonstrated in various clinical trials, yielding promising results. This review aims to explore recent advancements in the embolic materials used during GAE, examining their properties and potential benefits. Additionally, it will describe the use of pre-, intra-, and postprocedural imaging-particularly magnetic resonance imaging and other modalities-to optimize GAE outcomes.
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Affiliation(s)
- Maedeh Rouzbahani
- Advanced Diagnostic and Interventional Radiologic Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Husnain
- Department of Radiology, King Edward Medical University, Lahore, Pakistan
| | - Wali Badar
- Department of Radiology, Section of Interventional Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
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13
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Dalili D, Holzwanger DJ, Fleming JW, Igbinoba Z, Dalili DE, Beall DP, Isaac A, Yoon ES. Advanced Interventional Procedures for Knee Osteoarthritis: What Is the Current Evidence? Semin Musculoskelet Radiol 2024; 28:267-281. [PMID: 38768592 DOI: 10.1055/s-0044-1781432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The prevalence of knee osteoarthritis (OA) is the highest among all joints and likely to increase over the coming decades. Advances in the repertoire of diagnostic capabilities of imaging and an expansion in the availability and range of image-guided interventions has led to development of more advanced interventional procedures targeting pain related to OA pain while improving the function of patients presenting with this debilitating condition. We review the spectrum of established advanced interventional procedures for knee OA, describe the techniques used to perform these procedures safely, and discuss the clinical evidence supporting each of them.
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Affiliation(s)
- Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, United Kingdom
- Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, London, United Kingdom
| | - Daniel J Holzwanger
- Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
| | - Jacob W Fleming
- Comprehensive Specialty Care, Edmond, Oklahoma City, Oklahoma
| | - Zenas Igbinoba
- Department of Radiology, Hospital for Special Surgery, New York, New York
| | - Daniel E Dalili
- Department of Radiology, Southend University Hospital, Mid and South Essex NHS Trust, United Kingdom
| | - Douglas P Beall
- Comprehensive Specialty Care, Edmond, Oklahoma City, Oklahoma
| | - Amanda Isaac
- School of Biomedical Engineering & Imaging Sciences, Kings College London, London, United Kingdom
| | - Edward S Yoon
- Department of Radiology, Hospital for Special Surgery, New York, New York
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14
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O’Brien S, Blakeney WG, Soares J. Selective Genicular Artery Embolization in the Management of Osteoarthritic Knee Pain-A Narrative Review. J Clin Med 2024; 13:3256. [PMID: 38892967 PMCID: PMC11173069 DOI: 10.3390/jcm13113256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Many people with pain from osteoarthritis (OA) of the knee are either not ready for surgery or may never be surgical candidates. Genicular artery embolization (GAE) is a new proposed management for those with pain despite maximum medical management. It has historically been used to manage recurrent spontaneous haemarthrosis following total knee replacement, but newer studies are showing a positive effect in managing pre-arthroplasty knee OA. The goal of this review is to summarise current and relevant literature from searches of computerised databases and relevant journals, and analyse their results. Studies included show that GAE has promising outcomes in managing mild to moderate OA knee pain in those who have exhausted at least 3 months of conservative therapy. Most studies show improvements in VAS pain and PROM scores (including KOOS, and/or WOMAC). Minimal adverse effects have been associated in up to two years of follow up, the majority of which are self-resolving. The article précises a concise general procedural technique for performing GAE, as well as comparing and contrasting different embolic agents that may be utilised. GAE shows promising outcomes in management of mild to moderate OA knee pain. In the future, there will need to be higher volume studies to determine effectiveness, suitable candidates, and other potential adverse effects.
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Affiliation(s)
- Stephanie O’Brien
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - William G. Blakeney
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Julian Soares
- Department of Radiology, Royal Perth Hospital, Perth, WA 6000, Australia
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15
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Nakanishi S, Tsutsumi M, Kitano M, Kitagawa T, Miyashita T, Wada M, Kudo S. Effect of isometric quadriceps exercise on local microcirculation of the infrapatellar fat pad in female patients with knee osteoarthritis. Osteoarthritis Cartilage 2024:S1063-4584(24)01208-1. [PMID: 38824995 DOI: 10.1016/j.joca.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/01/2024] [Accepted: 05/23/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To elucidate the local microcirculation of the infrapatellar fat pad (IFP) in patients with knee osteoarthritis (KOA) by determining the changes in IFP hardness and hemoglobin concentration during isometric quadriceps exercise (IQE). DESIGN In this observational cross-sectional study, patients diagnosed with bilateral KOA were included in the KOA group (30 knees), healthy older adults in the control group (20 knees), and younger adults in the young group (20 knees). Ultrasonography was performed at rest and during IQE to measure IFP hardness based on shear wave velocity. Near-infrared spectroscopy was performed to measure oxygenated hemoglobin (O2Hb), deoxygenated hemoglobin (HHb), and total hemoglobin (cHb) in the IFP before (Baseline), during (IQE task), and after IQE (Post). IFP hardness and O2Hb, HHb, and cHb concentration were analyzed using a linear mixed model for the groups and measurement points. RESULTS During IQE, IFP hardness changes were significantly less in the KOA group than in the other groups (KOA: 95 % confidence intervals (CIs) [-0.854, 0.028]; control: 95 % CI [-0.941, -0.341]; and young: 95 % CI [-2.305, -1.706]). In the KOA group, O2Hb concentration exhibited no significant changes at Post compared with Baseline; however, significant changes were observed in the other groups (KOA: 95 % CI [-1.176, 0.423]; control: 95 % CI [-1.452, -0.276]; and young: 95 % CI [-4.062, -2.102]). CONCLUSIONS During IQE, changes in hardness and hemoglobin concentration in the IFP were not significant in the KOA group, suggesting impaired local microcirculation of the IFP.
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Affiliation(s)
- Syoya Nakanishi
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; Wada Orthopaedic Clinic, Osaka, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Masashi Kitano
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; mediVR, Inc., Tokyo, Japan
| | - Takashi Kitagawa
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; Department of Rehabilitation, Higashiosaka Hospital, Osaka, Japan
| | - Toshinori Miyashita
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; Osaka Bay Clinic, Morinomiya University of Medical Sciences, Osaka, Japan
| | | | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan; Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan; AR-Ex Medical Research Center, Tokyo, Japan.
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16
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Little MW, O'Grady A, Briggs J, Gibson M, Speirs A, Al-Rekabi A, Yoong P, Ariyanayagam T, Davies N, Tayton E, Tavares S, MacGill S, McLaren C, Harrison R. Genicular Artery embolisation in Patients with Osteoarthritis of the Knee (GENESIS) Using Permanent Microspheres: Long-Term Results. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03752-7. [PMID: 38819473 DOI: 10.1007/s00270-024-03752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE To report the 2-year follow-up of patients with mild-to-moderate knee osteoarthritis (OA) treated with genicular artery embolisation (GAE) as part of the GENESIS study. MATERIALS AND METHODS Forty-six patients, median age = 60 (45-83) underwent GAE using permanent microspheres (100-300 μm). Technical success was defined as embolisation of the targeted genicular arteries. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Visual Analogue Scale (VAS) (0-100 mm) were recorded at baseline, 6 weeks, 3 months, 1, 2 years. Contrast-enhanced MRI knee scans were acquired at baseline and 1 year, and evaluated with the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Functional MRI brain imaging and psychometric assessments were undertaken to investigate correlation between neuropsychological phenotypes and clinical outcome. Adverse events were recorded prospectively. RESULTS Technical success was achieved in forty patients (87%). Mean VAS improved from 58.63 (SD = 20.57, 95% CI 52.7-65.5) at baselines to 37.7 at 2-years (SD = 26.3, 95% CI 27.0-47.5). Whole and subgroup KOOS were significantly improved at each timepoint with associated reductions in analgesia usage. WORMS analysis demonstrated significant reduction in synovitis (p < 0.05) with no cases of osteonecrosis. Self-limiting skin discolouration occurred in four patients. A self-limiting groin haematoma and single case of deep-vein thrombosis due to immobilisation were also recorded. Nine patients subsequently underwent knee arthroplasty with no additional operational complexities identified. Neuropsychometric assessment elucidated a correlation between baseline catastrophising and greater reduction in pain post GAE. CONCLUSION GAE is a safe intervention for mild-moderate knee osteoarthritis, with sustained efficacy at 2 years. These results are promising and justify ongoing controlled trials.
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Affiliation(s)
- M W Little
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK.
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - A O'Grady
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - J Briggs
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Gibson
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - A Speirs
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - A Al-Rekabi
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - P Yoong
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - T Ariyanayagam
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - N Davies
- Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - E Tayton
- Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - S Tavares
- Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - S MacGill
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - C McLaren
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - R Harrison
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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17
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Kaneko F, Katayama S, Kudo S. Posterior Tibial Artery Blood Flow Velocity Is Increased in Patients with Plantar Heel Pain. J Clin Med 2024; 13:3153. [PMID: 38892865 PMCID: PMC11172846 DOI: 10.3390/jcm13113153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/25/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: This study aimed to investigate the relationship between posterior tibial artery blood flow velocity and plantar heel pain (PHP). Methods: The PHP group comprised patients diagnosed with plantar fasciitis with plantar heel pain during gait, and the control group comprised healthy participants without plantar heel pain. The peak systolic velocity of the posterior tibial artery was measured using ultrasonography; it was measured three times on each side, and the mean value was calculated. Receiver operating characteristic curve analysis was performed to calculate the peak systolic velocity cutoff value for plantar heel pain. Results: 23 patients (age 58.0 ± 16.5 years; 13 males and 10 females) and 23 healthy participants (age 51.3 ± 17.3 years; 10 males and 13 females) formed the PHP and control groups, respectively. Peak systolic velocity on the affected side was significantly greater in the PHP group (44.1 ± 13.1 cm/s) than in the control group (32.7 ± 5.9 cm/s). No significant difference was observed between the left and right sides in the PHP (7.1 ± 9.8 cm/s) and control (3.7 ± 3.0 cm/s) groups. A cutoff value of 38.2 cm/s was observed on the affected side. Conclusions: We quantified the increase in posterior tibial artery blood flow velocity in patients with plantar heel pain. Peak systolic velocity measurements can aid in quantitatively evaluating these patients. This study was registered as a clinical trial (UMIN000046875) on 1 October 2021.
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Affiliation(s)
- Fumiya Kaneko
- Inclusive Medical Science Research Institute, 1-26-16 Nankokita, Suminoe Ward, Osaka 559-8611, Japan;
- Department of Rehabilitation, Meidaimae Orthopedic Clinic, 1-38-25, Matsubara Setagaya Ward, Tokyo 156-0043, Japan;
- AR-Ex Medical Research Center, 4-13-1, Todoroki Setagaya, Tokyo 158-0082, Japan
| | - Sho Katayama
- Department of Rehabilitation, Meidaimae Orthopedic Clinic, 1-38-25, Matsubara Setagaya Ward, Tokyo 156-0043, Japan;
| | - Shintarou Kudo
- Inclusive Medical Science Research Institute, 1-26-16 Nankokita, Suminoe Ward, Osaka 559-8611, Japan;
- AR-Ex Medical Research Center, 4-13-1, Todoroki Setagaya, Tokyo 158-0082, Japan
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18
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Kılıçkesmez Ö, Dablan A, Güzelbey T, Cingöz M, Mutlu İN. Comparative Analysis of Transpedal and Transfemoral Access During Genicular Artery Embolization for Knee Osteoarthritis. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03757-2. [PMID: 38789570 DOI: 10.1007/s00270-024-03757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE This retrospective study aimed to compare the efficacy and safety of transpedal access (TPA) with transfemoral access (TFA) in Genicular Artery Embolization (GAE). MATERIALS AND METHODS 60 patients who underwent GAE between January and June 2023, were recruited and outcomes were compared between the TFA (n = 37) and TPA (n = 23) groups. Technical and clinical success rates, complications, and patient-reported outcomes were assessed. RESULTS All patients attained a 100% technical success rate, which was defined as the successful selective catheterization and embolization of at least one feeding artery to the knee joint, without encountering any major complications. Minor complications, observed in 12/60 patients (20%), were predominantly manifested as a transient skin discoloration. The TPA group had a comparatively higher (p = 0.008) rate of minor complication than the TFA group. Notably, TPA was associated with a longer duration of the procedure (p = 0.013), duration of fluoroscopy (p = 0.004), increased total air kerma (p = 0.037), dose-area product values (p = 0.021), and a greater incidence of vasospasm (p = 0.018) than TFA. However, TPA patients reported shorter recovery times and less post-procedural discomfort, especially reduced back pain due to postinterventional bedrest (p < 0.001). At the 3-month follow-up, the clinical success rate was similar between the two groups (p = 0.905). CONCLUSION TFA is the safer and faster method for GAE, offering fewer complications and reduced radiation exposure. For patients with challenging groin anatomies, however, TPA may provide a valuable alternative.
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Affiliation(s)
- Özgür Kılıçkesmez
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, 34488, Istanbul, Turkey
| | - Ali Dablan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, 34488, Istanbul, Turkey.
| | - Tevfik Güzelbey
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, 34488, Istanbul, Turkey
| | - Mehmet Cingöz
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, 34488, Istanbul, Turkey
| | - İlhan Nahit Mutlu
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, 34488, Istanbul, Turkey
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Wilms LM, Jannusch K, Weiss D, Steinfort N, Ziayee F, Antoch G, Minko P. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. ROFO-FORTSCHR RONTG 2024. [PMID: 38740066 DOI: 10.1055/a-2288-5743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Osteoarthritis (OA) is a chronic degenerative disease significantly impacting both patient quality of life and socioeconomics. Traditional treatment options, including pharmacological and surgical interventions, are often limited. Advancements in our understanding of the pathological mechanisms behind OA indicate the involvement of pathological angiogenesis. Transarterial microembolization (TAME), a minimally invasive radiological procedure, may present an innovative therapeutic approach. This review aims to consolidate current knowledge and experiences regarding TAME as a therapeutic modality for alleviating chronic joint pain associated with OA. It explores the role of TAME, focusing on its indications, patient selection, clinical outcomes, and future perspectives. Potential complications and associated risks are systematically addressed, alongside proposed strategies for risk mitigation and effective management.The presented patient cases originate from our institution, supplemented by a thorough review of relevant literature retrieved from PubMed.TAME represents a promising therapeutic approach, providing relief from the burden of joint diseases and substantially enhancing patient quality of life. Clinical outcomes emphasize the efficacy and safety of TAME in mitigating pain and improving functional capabilities in patients with chronic joint pain associated with OA. With mounting evidence of its therapeutic benefits and applicability to numerous joint-related pathologies, TAME offers a valuable addition to the arsenal of treatments for these conditions. · TAME is an innovative therapy for treating chronic joint pain related to OA.. · TAME is a technically challenging minimally invasive intervention requiring a high level of expertise.. · Understanding the challenges and complications of TAME can reduce risk and enhance procedural outcomes.. · Wilms LM, Jannusch K, Weiss D et al. Transarterial microembolization for the management of refractory chronic joint pain in osteoarthritis. Fortschr Röntgenstr 2024; DOI 10.1055/a-2288-5743.
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Affiliation(s)
- Lena Marie Wilms
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Kai Jannusch
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Daniel Weiss
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Nilcolas Steinfort
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Farid Ziayee
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
| | - Peter Minko
- Diagnostic and Interventional Radiology, Heinrich-Heine-Universitat Düsseldorf, Düsseldorf, Germany
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20
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Lin HY, Liang KW, Wang B, Lee CC. Challenges and complications and their management of the transarterial microembolization for chronic musculoskeletal pain. Eur Radiol 2024; 34:3260-3270. [PMID: 37853172 DOI: 10.1007/s00330-023-10328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
Transarterial microembolization (TAME) is an increasingly well-known novel and minimally invasive treatment option for painful chronic musculoskeletal diseases that is gaining popularity. Although the safety and effectiveness of TAME have been established, limited knowledge of intraarticular and musculocutaneous arterial anatomy may lead to challenges and complications. This article aims to present cases illustrating these challenges and complications, based on multicenter experiences and a comprehensive literature review. Furthermore, the article also provides preventive tips, solutions, and follow-up strategies to reduce the learning curve for interventional radiologists and facilitate familiarity with post-TAME follow-up images for diagnostic radiologists. CLINICAL RELEVANCE STATEMENT: This article illustrates the intra- and post-interventional complications of transarterial microembolization (TAME) through detailed pictorial reviews, including how to distinguish them from normal angiographic findings. It provides strategies for their prevention, management, and follow-up, which can further improve clinical outcomes. KEY POINTS: • Transarterial microembolization for chronic musculoskeletal pain may result in intrainterventional challenges (IIC) and postinterventional complications (PIC), and their importance may be underestimated. • The intrainterventional challenges include microarterial perforation, arterial dissection, and catheter tip fracture, whereas postinterventional complications include tissue ischemia-related complications, puncture site hemorrhage, and arterial injury. • Being familiar with the intrainterventional challenges and postinterventional complications may help minimize the procedure risk and improve outcomes.
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Affiliation(s)
- Hsuan-Yin Lin
- Department of Radiology, Taichung Veterans General Hospital, No.1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705, Republic of China.
| | - Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, 402, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan
| | - Cheng-Chun Lee
- Department of Medical Imaging, Tungs' Taichung Metroharbor Hospital, Taichung, 435, Taiwan
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21
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Liu S, Swilling D, Morris EM, Macaulay W, Golzarian J, Hickey R, Taslakian B. Genicular Artery Embolization: A Review of Essential Anatomic Considerations. J Vasc Interv Radiol 2024; 35:487-496.e6. [PMID: 38128722 DOI: 10.1016/j.jvir.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
Genicular artery embolization is increasingly recognized as a safe and effective treatment option for symptomatic knee osteoarthritis and recurrent hemarthrosis after total knee arthroplasty. Genicular arteries are an essential contributor to vascular supply for the knee joint and demonstrate considerable variability. Familiarity with the anatomy and common variations is critical for preprocedural planning, accurate target selection, and minimizing adverse events in transarterial embolization procedures. This review aimed to provide a detailed discussion of the genicular artery anatomy that is relevant to interventional radiologists performing genicular artery embolization.
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Affiliation(s)
- Shu Liu
- Department of Radiology, NYU Langone Health, New York, New York
| | - David Swilling
- Department of Radiology, NYU Langone Health, New York, New York
| | | | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota; Northstar Vascular and Interventional Center, Golden Valley, Minnesota
| | - Ryan Hickey
- Department of Radiology, NYU Langone Health, New York, New York
| | - Bedros Taslakian
- Department of Radiology, NYU Langone Health, New York, New York.
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22
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Lanciego C, Puentes-Gutierrez A, Sánchez-Casado M, Cifuentes-Garcia I, Fernández-Tamayo A, Dominguez-Paillacho D, Ciampi-Dopazo JJ, Marquina-Valero MA. Transarterial Embolization for Adhesive Capsulitis of the Shoulder: Midterm Outcomes on Function and Pain Relief. J Vasc Interv Radiol 2024; 35:550-557. [PMID: 38199458 DOI: 10.1016/j.jvir.2023.12.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To determine the safety and potential effectiveness of transarterial embolization for adhesive capsulitis of the shoulder. MATERIALS AND METHODS This prospective study analyzed consecutive adult patients with adhesive capsulitis referred for embolization between January 2018 and May 2023 after a poor response to treatment (symptoms and limitation of motion in ≥2 axes; ≤120° flexion, ≤50° external rotation and/or internal rotation with the shoulder abducted 90°) persisting for >3 months after having completed ≥6 weeks of analgesics and physical therapy. Different types of pain and mobility were measured before embolization and 1, 3, and 6 months after embolization. Overall upper limb function (Quick Disabilities of Arm, Shoulder, and Hand) and patient satisfaction were measured before and 6 months after embolization. Long-term follow-up comprised telephone interviews and clinical history reviews. RESULTS A total of 20 patients (12 [60%] women; median age, 50.7; interquartile ranges [IQR], 45‒55 years) were included; 6 (30%) had diabetes and 15 (75%) were off work. Median duration of symptoms before embolization was 39.4 weeks (IQR, 28‒49 weeks), and median duration of rehabilitation therapy was 12.8 weeks (IQR, 8‒16 weeks). Six months after embolization, significant improvements were observed in nocturnal pain (P = .003), pain on moving (P = .001), external rotation (P < .001), internal rotation (P < .001), active flexion (P < .001), passive flexion (P = .03), active abduction (P < .001), passive abduction (P < .001), and overall function (P < .001). Despite objective improvements, patient satisfaction was nearly unchanged. Only 1 patient experienced a mild adverse event. CONCLUSION Transarterial embolization is safe and potentially effective in treating adhesive capsulitis of the shoulder refractory to conventional treatment. Clinical improvements were maintained in the mid to long term.
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Affiliation(s)
- Carlos Lanciego
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
| | - Ana Puentes-Gutierrez
- Rehabilitation and Physical Medicine Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Marcelino Sánchez-Casado
- Biostatistics Unit, Intensive Care Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Irene Cifuentes-Garcia
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Ana Fernández-Tamayo
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - David Dominguez-Paillacho
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Juan J Ciampi-Dopazo
- Interventional Radiology Unit, Radiology Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Maria A Marquina-Valero
- Rehabilitation and Physical Medicine Department, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
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23
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Nakamura H, Yamamoto A, Fukunaga T, Watanabe H, Ito K, Higaki A, Kanki A, Fukukura Y, Tamada T. In vitro study of the embolic characteristics of imipenem/cilastatin particles. CVIR Endovasc 2024; 7:27. [PMID: 38466503 DOI: 10.1186/s42155-024-00441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Imipenem/cilastatin (IPM/CS) has long been administered intravenously as a carbapenem antibiotic. However, since this agent is poorly soluble in liquid, occasional reports have described its use as a short-acting, temporary embolic agent. The purpose of this study was to elucidate the characteristics of IPM/CS particles, which are thought to have pain-relieving effects against osteoarthritis-related pain, as an embolic agent. METHODS Three aspects of IPM/CS as an embolic agent were evaluated in vitro: particle size; particle shape; and change in particle size over time. For particle size, the long diameter was measured. RESULTS Mean particle size (n=244) was 29.2±12.0 µm (range, 1-60 µm). Shape (n=109) was round in 18.35%, elliptical in 11.93%, and polygonal in 69.72%, showing that most particles were polygonal. In observations of changes in particle size over time (n=9), particles had decreased to 75% of their original size at 82±10.7 min, 50% at 89.3±9.14 min, 25% at 91.3±8.74 min, complete dissolved at 91.8±9.02 min. A rapid shrinkage in diameter was seen in the final period. CONCLUSIONS IPM/CS particles are ultrafine and the majority display a polygonal shape. This substance shows ultra-short embolic activity. This study revealed the characteristics of a substance that demonstrates an embolic effect not found in existing embolic materials.
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Affiliation(s)
- Hiroki Nakamura
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan.
| | - Akira Yamamoto
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Takeshi Fukunaga
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Hiroyuki Watanabe
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Kosuke Ito
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Atushi Higaki
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Akihiko Kanki
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Yoshihiko Fukukura
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, 577 , Matsushima, Kurashiki City, Okayama, Japan
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24
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Gorsi U, Singh D, Kang M, Kumar V, Prakash M, B.C S. Safety and Efficacy of Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis-Initial Indian Experience. Indian J Radiol Imaging 2024; 34:37-43. [PMID: 38106876 PMCID: PMC10723963 DOI: 10.1055/s-0043-1771159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background Osteoarthritis (OA) is the commonest form of arthritis with pain and disability as hallmark symptoms. Despite various nonpharmacologic, pharmacologic, and surgical approaches, pain control may be hard to achieve. Over the last few years, few studies have been conducted on managing knee OA using novel endovascular genicular artery embolization (GAE) with varied outcomes. No such study has been reported in India yet to the best of our knowledge. Purpose The main aim of this article was to evaluate the efficacy and safety of transcatheter GAE in relieving knee pain in patients with mild-to-moderate OA. Materials and Methods Ten patients with radiographic knee OA and moderate-to-severe pain refractory to conservative therapy were enrolled in a prospective observational study. GAE was performed with 100 to 300-μm spherical particles. Patients were assessed with magnetic resonance imaging at the baseline. Visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess pain and disability respectively at the baseline, 1 month, and 3 months. Clinical success was asserted by the downstaging of VAS and WOMAC scores. Adverse events were recorded at all-time points. Descriptive and inferential statistics have been performed using SPSS. A p -Value less than 0.05 was considered statistically significant. Results Embolization of at least 1 genicular artery was achieved in all the patients (100%). Clinical success was demonstrated in 08 (80%) of the patients. Median VAS reduced from 07 at baseline to 3.5 at 3-month follow-up ( p < 0.001). Median WOMAC score improved from 53 to 23.50 at 3-month follow-up ( p < 0.001). Minor complications were seen in two patients in the form of puncture site hematoma and mild petechial spots over the knee. Conclusion Our pilot study demonstrates GAE as a safe and efficacious procedure to treat knee pain secondary to OA. Further randomized comparative studies with a larger sample size are needed to determine the true treatment effect versus the placebo effect.
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Affiliation(s)
- Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Damandeep Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B.C
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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25
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Taslakian B, Swilling D, Attur M, Alaia EF, Kijowski R, Samuels J, Macaulay W, Ramos D, Liu S, Morris EM, Hickey R. Genicular Artery Embolization for Treatment of Knee Osteoarthritis: Interim Analysis of a Prospective Pilot Trial Including Effect on Serum Osteoarthritis-Associated Biomarkers. J Vasc Interv Radiol 2023; 34:2180-2189.e3. [PMID: 37640104 DOI: 10.1016/j.jvir.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE To characterize the safety, efficacy, and potential role of genicular artery embolization (GAE) as a disease-modifying treatment for symptomatic knee osteoarthritis (OA). MATERIALS AND METHODS This is an interim analysis of a prospective, single-arm clinical trial of patients with symptomatic knee OA who failed conservative therapy for greater than 3 months. Sixteen patients who underwent GAE using 250-μm microspheres and had at least 1 month of follow-up were included. Six patients completed the 12-month follow-up, and 10 patients remain enrolled. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was evaluated at baseline and at 1, 3, and 12 months. Serum and plasma samples were collected for biomarker analysis. The primary end point was the percentage of patients who achieved the minimal clinically important difference (MCID) for WOMAC pain score at 12 months. Baseline and follow-up outcomes were analyzed using the Wilcoxon matched-pairs signed-rank test. RESULTS Technical success of the procedure was 100%, with no major adverse events. The MCID was achieved in 5 of the 6 (83%) patients at 12 months. The mean WOMAC pain score decreased from 8.6 ± 2.7 at baseline to 4.9 ± 2.7 (P = .001), 4.4 ± 2.8 (P < .001), and 4.7 ± 2.7 (P = .094) at 1, 3, and 12 months, respectively. There was a statistically significant decrease in nerve growth factor (NGF) levels at 12 months. The remaining 8 biomarkers showed no significant change at 12 months. CONCLUSIONS GAE is a safe and efficacious treatment for symptomatic knee OA. Decreased NGF levels after GAE may contribute to pain reduction and slowing of cartilage degeneration.
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Affiliation(s)
- Bedros Taslakian
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York.
| | - David Swilling
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Mukundan Attur
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, New York
| | - Erin F Alaia
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York; Division of Musculoskeletal Imaging, Department of Radiology, NYU Langone Health, New York, New York
| | - Richard Kijowski
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York; Division of Musculoskeletal Imaging, Department of Radiology, NYU Langone Health, New York, New York
| | - Jonathan Samuels
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, New York
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Danibel Ramos
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Shu Liu
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Elizabeth M Morris
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
| | - Ryan Hickey
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, New York
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26
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Badar W, Anitescu M, Ross B, Wallace S, Uy-Palmer R, Ahmed O. Quantifying Change in Perfusion after Genicular Artery Embolization with Parametric Analysis of Intraprocedural Digital Subtraction Angiograms. J Vasc Interv Radiol 2023; 34:2190-2196. [PMID: 37673399 DOI: 10.1016/j.jvir.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
PURPOSE To quantify perfusion changes during genicular artery embolization (GAE) with the qualitatively described "pruning" technique using parametric analysis. MATERIALS AND METHODS A total of 12 patients underwent unilateral GAE with a total of 36 vessels embolized. Among 34 of the 36 vessels embolized, regions of interest (ROIs) were placed on parent vessels (PVs) and hyperemic target vessels (TVs) before and after GAE. For each ROI, peak intensity (PI), time to arrival (TTA), and area under the curve (AUC) were computed and compared between PV and TV. Volume of embolic administered was correlated with adverse events. RESULTS No change was seen in PI, TTA, and AUC in the PV after GAE. Reduction in AUC (1,495.7 ± 521.5 vs 1,667.4 ± 574.0; P << .01) and PI (195.1 ± 43.8 vs 224.3 ± 49.2; P << .01) with increase in TTA (3.42 s ± 1.70 vs 1.92 s ± 1.45; P << .01) within the TV were observed after GAE. Median follow-up time was 89 days (range, 21-254 days). Reduction in clinical symptoms was also noted based on the Western-Ontario and McMaster Universities Arthritis Index total and pain scale at 1 month (total, 42.9% ± 23.0; pain, 54.4% ± 9.8; P << .01) and 3 months (total, 42.5% ± 14.9; pain, 57.8% ± 10.6; P << .01). Eight total mild adverse events (minor/self-limiting) were noted per Society of Interventional Radiology guidelines. A larger volume of embolic was observed in knees with skin changes (3.4 mL ± 0.4 vs 1.7 mL ± 0.4; P << .001). Furthermore, all skin changes were seen with embolic volumes >3.0 mL. CONCLUSIONS Quantification of intraprocedural perfusion changes with GAE demonstrated reduced flow to the TV with maintained flow in the PV and acceptable clinical outcomes. A potential relationship between embolic volume and nontarget embolization was also highlighted.
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Affiliation(s)
- Wali Badar
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. https://twitter.com/walsterIR
| | - Magdalena Anitescu
- Division of Pain Management, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois. https://twitter.com/MagdaAnitescuMD
| | - Brendon Ross
- Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Sara Wallace
- Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois
| | - Rosemary Uy-Palmer
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Division of Interventional Radiology, Department of Radiology, University of Chicago, Chicago, Illinois.
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27
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Sajan A, Lerner J, Kasimcan MO, Isaacson A, Pavidapha A, Piechowiak R, Bagla S. Feasibility and Technique of Retrograde Pedal Access for Genicular Artery Embolization. J Vasc Interv Radiol 2023; 34:2030-2033. [PMID: 37495097 DOI: 10.1016/j.jvir.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Abin Sajan
- Department of Radiology, Columbia University Irving Medical Center, New York, New York.
| | - Jade Lerner
- St. George's University, Great River, New York
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28
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Cusumano LR, Callese TE, Redwood K, Genshaft S, Plotnik AN, Stewart JK, Padia SA. Added Value of Cone-Beam CT to Identify Arterial Supply during Genicular Artery Embolization for Knee Osteoarthritis. J Vasc Interv Radiol 2023; 34:1861-1867. [PMID: 37573000 DOI: 10.1016/j.jvir.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/05/2023] [Accepted: 07/23/2023] [Indexed: 08/14/2023] Open
Abstract
PURPOSE To evaluate if the addition of cone-beam computed tomography (CT) to digital subtraction angiography (DSA) improves the identification of the genicular arteries during genicular artery embolization (GAE) for knee pain secondary to osteoarthritis (OA). MATERIALS AND METHODS This single-center study retrospectively analyzed 222 patients who underwent GAE for painful knee OA between May 2018 and April 2022. Intraprocedural cone-beam CT and DSA images were reviewed independently by 2 sets of interventional radiologists. DSA was performed for all patients. Technically adequate cone-beam CT was available for 205 patients (92.3%). The presence of the genicular arteries identified by cone-beam CT and DSA was compared using Φ coefficients. Embolization targets identified by both cone-beam CT and DSA were evaluated against those identified by DSA alone. RESULTS Genicular arteries with the highest concordance between cone-beam CT and DSA were the inferior lateral (196 vs 198; Φ = 0.3530; P < .0001), superior lateral (197 vs 200; Φ = 0.3060; P < .0001), and superior medial genicular (186 vs 161; Φ = 0.2836; P < .0001) arteries. Cone-beam CT demonstrated higher rates of detection of the inferior medial (195 vs 178; Φ = 0.04573; P = .5150) and median genicular arteries (200 vs 192; Φ = 0.04573; P = .5150). Meanwhile, genicular arteries less frequently identified by cone-beam CT were the descending genicular (197 vs 200; Φ = -0.03186; P = .6502), superior patellar (175 vs 184; Φ = 0.1332; P = .0569), and recurrent anterior tibial (156 vs 186; Φ = 0.01809; P = .7969) arteries. Cone-beam CT in combination with DSA identified 13.4% (372 vs 328) more targets compared to DSA alone. CONCLUSIONS Based on the results of the current study, cone-beam CT serves as a valuable adjunct for visualizing the genicular arteries during GAE, and together with DSA, it identifies more potential embolization targets.
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Affiliation(s)
- Lucas R Cusumano
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Tyler E Callese
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Karen Redwood
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott Genshaft
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Adam N Plotnik
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jessica K Stewart
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
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29
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Barge TF, Little MW. Musculoskeletal Embolotherapy. Cardiovasc Intervent Radiol 2023; 46:1517-1524. [PMID: 36352126 DOI: 10.1007/s00270-022-03302-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022]
Abstract
Painful articular musculoskeletal (MSK) conditions are common, debilitating and sometimes difficult to treat. Transcatheter embolisation may offer an alternative way to manage the pain associated with these conditions, but the field is still in its infancy. To date, the most commonly studied indication is knee osteoarthritis, but the technique has been trailed in multiple other tissue beds, including for adhesive capsulitis and tendinopathies. Whilst early results appear promising, the existing studies are mostly open-labelled and non-randomised; there is a need for high-quality evidence to robustly assess the procedures efficacy. In this review, we set out to evaluate the current evidence underlying the pathophysiology and mechanism of action of embolisation; discuss the technical aspects of the procedure including embolic selection, and appraise the published clinical outcomes and adverse effects. Finally, we discuss the future directions and research priorities in this rapidly developing field.
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Affiliation(s)
- T F Barge
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M W Little
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK.
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30
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Min J, Park SW, Hwang JH, Lee JK, Lee DW, Kwon YW, Shin KC. Evaluating the Safety and Effectiveness of Quick-Soluble Gelatin Sponge Particles for Genicular Artery Embolization for Chronic Knee Pain Associated with Osteoarthritis. J Vasc Interv Radiol 2023; 34:1868-1874. [PMID: 37473861 DOI: 10.1016/j.jvir.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of genicular artery embolization (GAE) using quick-soluble gelatin sponge particles (QS-GSPs) to alleviate chronic knee pain associated with osteoarthritis. MATERIALS AND METHODS This retrospective study included 71 patients (97 procedures, including 26 patients for both knees) who underwent GAE to treat osteoarthritic knee pain between August 2019 and January 2022. QS-GSPs were used for all the procedures. Technical success was defined as the embolization of at least 1 feeding artery. Clinical outcomes were evaluated using a 10-point visual analog scale (VAS). Clinical success was defined as a decrease in the VAS score of >50%. RESULTS The technical success rate was 100% (97 of 97). The mean VAS scores at baseline, immediately after TAE, and at 1 day, 1 week, 1 month, 3 months, and 6 months after TAE were 6.3, 4.3, 5.0, 3.0, 2.9, 2.9, and 2.8, respectively. The clinical success rate was 72% (70 of 97 patients) at 6 months. No major adverse events were reported, and temporary skin color change (50.5%, 49 of 97) and hematoma at the puncture site (10.3%, 10 of 97) were observed. CONCLUSIONS GAE using QS-GSPs had a high technical success rate and was considered safe. Clinical outcomes using QS-GSPs were comparable with those of existing materials.
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Affiliation(s)
- Jeeyoung Min
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea.
| | - Jin Ho Hwang
- Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Yong Wonn Kwon
- Department of Interventional Radiology, Cheil Orthopedic Hospital, Seoul, Republic of Korea
| | - Kyu Cheol Shin
- Department of Interventional Radiology, Cheil Orthopedic Hospital, Seoul, Republic of Korea
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31
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Chau Y, Roux C, Gonzalez JF, Breuil V, Bernard de Dompsure R, Fontas E, Rudel A, Sédat J. Effectiveness of Geniculate Artery Embolization for Chronic Pain after Total Knee Replacement-A Pilot Study. J Vasc Interv Radiol 2023; 34:1725-1733. [PMID: 37391071 DOI: 10.1016/j.jvir.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA). MATERIALS AND METHODS Twelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points. RESULTS A mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week. CONCLUSION GAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months.
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Affiliation(s)
- Yves Chau
- Neurointerventionnal and Interventional Vascular Unit, CHU de Nice, Pasteur 2 Hospital, Nice, France.
| | - Christian Roux
- Department of Rheumatology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | | | - Véronique Breuil
- Department of Rheumatology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | | | - Eric Fontas
- Department of Clinical Research and Innovation, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | - Alexandre Rudel
- Department of Osteo-Articular Radiology, CHU de Nice, Pasteur 2 Hospital, Nice, France
| | - Jacques Sédat
- Neurointerventionnal and Interventional Vascular Unit, CHU de Nice, Pasteur 2 Hospital, Nice, France
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Kubo T, Miyazaki K, Shibuya M, Sugihara E, Nakata M, Okuno Y. Intra-Arterial Injection of Temporary Embolic Material Through a Needle Inserted into the Radial or Ulnar Artery for Distal and Proximal Interphalangeal Joint Osteoarthritis: A Retrospective Study of 92 Patients. Cardiovasc Intervent Radiol 2023; 46:1375-1382. [PMID: 37524895 DOI: 10.1007/s00270-023-03514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To assess the efficacy and safety of intra-arterial injection of imipenem/cilastatin sodium (IPM/CS) via a needle placed into the radial artery or ulnar artery (RA/UA) for distal interphalangeal and proximal interphalangeal joint osteoarthritis (DIP/PIP-OA). MATERIALS AND METHODS This is a retrospective single-arm cohort study. Ninety-two patients [92% women, mean (SD) age 55(8.3) years] with a primary DIP/PIP-OA meet the American College of Rheumatology criteria for hand osteoarthritis with pain ≥ 4 on the 0-10 numeric rating scale (NRS) were enrolled. All procedures were performed by injecting IPM/CS through a 24-gauge needle percutaneously inserted into the RA/UA. Two procedures were planned; the second procedure was scheduled 1-2 months after the first. NRS, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Patient Global Impression of Change (PGIC) scale, and procedure-related adverse events were evaluated. RESULTS Technical success, defined as injection of IPM/CS into the RA/UA, was achieved in all patients. Clinical success, defined as a reduction of 2 points or more in the NRS at 12 months, was 77% (95% confidence interval 68-85%). The NRS improved from the baseline to 3, 6, and 12 months (7.8 ± 1.6 vs. 3.8 ± 2.6, 3.9 ± 2.7, and 4.0 ± 2.8, respectively, all p < 0.001). The QuickDASH score improved from the baseline to 12 months (27 ± 15 vs. 19 ± 17, p < 0.001) respectively. No major adverse events were observed. CONCLUSIONS Intra-arterial injection of IPM/CS is a feasible treatment option for DIP/PIP-OA.
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Affiliation(s)
- Takatoshi Kubo
- Department of Radiology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Koichi Miyazaki
- Musculoskeletal Intervention Center, Okuno Clinic Osaka, 3rd Fl Shinsaibashi Front Bldg., 3-5-11, Minamifunaba, Chuo-ku, Osaka City, Osaka, 542-0081, Japan
| | - Masahiko Shibuya
- Musculoskeletal Intervention Center, Okuno Clinic Kobe, B1 Fl, 1-2-1, Sannomiyacho, Chuo-ku, Kobe City, Hyogo, 650-0021, Japan
| | - Eiji Sugihara
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Masaya Nakata
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan
| | - Yuji Okuno
- Musculoskeletal Intervention Center, Okuno Clinic Tokyo, 4th Fl Ginrei Bldg., 7-8-4, Roppongi, Minato-ku, Tokyo, 106-0032, Japan.
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Gill SD, Hely R, Hely A, Harrison B, Page RS, Landers S. Outcomes after Genicular Artery Embolization Vary According to the Radiographic Severity of Osteoarthritis: Results from a Prospective Single-Center Study. J Vasc Interv Radiol 2023; 34:1734-1739. [PMID: 37331590 DOI: 10.1016/j.jvir.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
This prospective single-center study compared outcomes after genicular artery embolization (GAE) in people with mild radiographic knee osteoarthritis (OA) (n = 11) versus moderate to severe radiographic knee OA (n = 22). The mild OA group was older and had experienced symptoms for less time (P < .05). All participants underwent complete embolization of neovessels from genicular arteries. The primary outcome was the proportion of responders at 6 months according to predetermined improvements in pain, function, and/or global change. Results indicated that a higher proportion of participants (n = 9, 81.8%) with mild OA fulfilled responder criteria after treatment compared with people with moderate to severe OA (n = 8, 36.4%) (P = .014). Secondary outcomes for pain, quality of life, and global change were also better in the mild OA group (P < .05). No serious adverse events occurred, including the absence of osteonecrosis on magnetic resonance imaging. The study demonstrated that outcomes after GAE varied according to the severity of baseline radiographic OA.
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Affiliation(s)
- Stephen D Gill
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia; School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia; Barwon Centre for Orthopaedic Research & Education, St John of God and Geelong Hospitals, Geelong, Victoria, Australia
| | - Rachael Hely
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia
| | - Andrew Hely
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia; Integral Diagnostics, Geelong, Victoria, Australia
| | - Benjamin Harrison
- Barwon Medical Imaging, Barwon Health, Geelong, Victoria, Australia; GIRADI Research Institute, Geelong, Victoria, Australia
| | - Richard S Page
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia; Barwon Centre for Orthopaedic Research & Education, St John of God and Geelong Hospitals, Geelong, Victoria, Australia
| | - Steve Landers
- GIRADI Research Institute, Geelong, Victoria, Australia; Clinical Precision, Geelong, Victoria, Australia.
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Padia SA. GENESIS 2 Trial: Unveiling the Potential of Genicular Artery Embolization. Cardiovasc Intervent Radiol 2023; 46:1283-1284. [PMID: 37532943 DOI: 10.1007/s00270-023-03516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Siddharth A Padia
- Section of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, 757 Westwood Plaza, Suite 2125, Los Angeles, CA, 90095, USA.
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Little MW, Harrison R, MacGill S, Speirs A, Briggs JH, Tayton E, Davies NLC, Hausen HS, McCann C, Levine LL, Sharma RA, Gibson M. Genicular Artery Embolisation in Patients with Osteoarthritis of the Knee (GENESIS 2): Protocol for a Double-Blind Randomised Sham-Controlled Trial. Cardiovasc Intervent Radiol 2023; 46:1276-1282. [PMID: 37337060 PMCID: PMC10471661 DOI: 10.1007/s00270-023-03477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
Knee osteoarthritis is a leading cause of chronic disability and economic burden. In many patients who are not surgical candidates, existing treatment options are insufficient. Clinical evidence for a new treatment approach, genicular artery embolisation (GAE), is currently limited to single arm cohort, or small population randomised studies. This trial will investigate the use of a permanent embolic agent for embolisation of abnormal genicular arterial vasculature to reduce pain in patients with mild to moderate knee osteoarthritis. Up to 110 participants, 45 years or older, with knee pain for ≥ 3 months resistant to conservative treatment will be randomised (1:1) to GAE or a sham procedure. The treatment group will receive embolisation using 100-micron Embozene™ microspheres (Varian, a Siemens Healthineers Company) (investigational use for this indication in the UK), and the sham group will receive 0.9% saline in an otherwise identical procedure. Patients will be followed for 24 months. At 6 months, sham participants will be offered crossover to GAE. The primary endpoint is change of 4 Knee Injury and OA Outcome Score subscales (KOOS4) at 6 months post-randomisation. The study will also evaluate quality of life, health economics, imaging findings, and psychosocial pain outcomes. The primary manuscript will be submitted for publication after all participants complete 6 months of follow-up. The trial is expected to run for 3.5 years. Trial Registration: ClinicalTrials.gov, Identifier: NCT05423587.
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Affiliation(s)
- Mark W Little
- University Department of Radiology, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK.
- Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK.
| | - Richard Harrison
- Centre for Integrative Neuroscience and Neurodynamics, University of Reading, Reading, UK
| | - Sarah MacGill
- University Department of Radiology, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK
| | - Archie Speirs
- University Department of Radiology, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK
| | - James H Briggs
- University Department of Radiology, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK
| | - Edward Tayton
- Department of Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | - Nev L C Davies
- Department of Orthopaedics, Royal Berkshire Hospital, Reading, UK
| | | | - Claire McCann
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | - Lisa L Levine
- Varian, a Siemens Healthineers Company, Palo Alto, USA
| | | | - Matthew Gibson
- University Department of Radiology, Royal Berkshire Hospital, London Road, Reading, RG1 5AN, UK
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Liang KW, Wang B, Huang HH, Tsao TF, Tyan YS, Wang PH. Effectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis-Related Interphalangeal Joint Pain. J Vasc Interv Radiol 2023; 34:1485-1492.e1. [PMID: 37295555 DOI: 10.1016/j.jvir.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of intra-arterial imipenem/cilastatin sodium (IPM/CS) infusion for painful interphalangeal joint osteoarthritis (OA). MATERIALS AND METHODS Fifty-eight patients with interphalangeal joint OA who underwent intra-arterial IPM/CS infusion were retrospectively evaluated. Intra-arterial infusions were performed via percutaneous wrist arterial access. The Numerical Rating Scale (NRS), Functional Index for Hand Osteoarthritis (FIHOA), and Patient Global Impression of Change (PGIC) scale scores were assessed at intervals of 1, 3, 6, 12, and 18 months. Clinical success was evaluated based on PGIC. RESULTS All patients were followed up for at least 6 months after treatment. Of them, 30 and 6 patients were followed up for 12 and 18 months, respectively. No severe or life-threatening adverse events were encountered. The mean NRS score was 6.0 ± 1.4 at baseline, which significantly decreased to 2.8 ± 1.4, 2.2 ± 1.9, and 2.4 ± 1.9 at 1, 3, and 6 months after treatment, respectively (all P < .001). The mean NRS scores were 2.8 ± 1.7 and 2.9 ± 1.9 at 12 and 18 months, respectively, in the remaining patients. The mean FIHOA score significantly decreased from 9.8 ± 5.0 at the baseline to 4.1 ± 3.5 at 3 months (P < .001). The mean FIHOA score was 4.5 ± 3.3 at 12 months in the remaining 30 patients. The clinical success rates based on PGIC at 1, 3, 6, 12, and 18 months were 62.1%, 77.6%, 70.7%, 63.4%, and 50.0%, respectively. CONCLUSIONS Intra-arterial IPM/CS infusion is a potential treatment option for interphalangeal joint OA refractory to medical management.
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Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Teng-Fu Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Braithwaite S, Qamhawi Z, Briggs J, Little MW. Transcatheter embolisation in chronic musculoskeletal disorders. Br J Radiol 2023; 96:20220728. [PMID: 37335189 PMCID: PMC10461266 DOI: 10.1259/bjr.20220728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/21/2023] Open
Abstract
Chronic musculoskeletal conditions affect millions of patients worldwide resulting in disability, reduced quality of life, and have a profound economic impact on the individual and society. Current treatment strategies fail patients who have not responded to conservative management but are not surgical candidates. Over the last decade, transcatheter embolisation has emerged as a potential treatment for these difficult to treat patients. By exploiting pathological neovascularisation within conditions such as knee osteoarthritis, adhesive capsulitis, and tendinopathy, embolisation has been used to improve patients' pain and function. This review explores the rationale for musculoskeletal transcatheter embolisation, illustrating the technique, and latest evidence for the most common procedures.
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Affiliation(s)
- Simon Braithwaite
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Zahi Qamhawi
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - James Briggs
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Mark W Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
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Poursalehian M, Bhia I, Ayati Firoozabadi M, Mortazavi SMJ. Genicular Artery Embolization for Knee Osteoarthritis: A Comprehensive Review. JBJS Rev 2023; 11:01874474-202309000-00004. [PMID: 37683080 DOI: 10.2106/jbjs.rvw.23.00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
» Genicular artery embolization (GAE) is a promising treatment option for patients with knee osteoarthritis who are unresponsive to nonsurgical treatments and not yet candidates for surgery.» Current evidence supports the effectiveness of GAE in reducing pain and synovitis, with few reported major adverse events.» The cost-effectiveness and long-term results of GAE compared with other treatment options require further investigation.» Limitations of existing studies include small sample sizes, single-center trials, and lack of comparison between embolic agents and other treatments.» Future research should focus on larger, multicenter trials with longer follow-up periods and head-to-head comparisons with alternative treatment modalities to establish the role of GAE in the management of knee osteoarthritis.
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Affiliation(s)
- Mohammad Poursalehian
- Joint Reconstruction Research Center, Orthopedic Surgery Department, Imam Khomeini Hospital, Tehran, Iran
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Wang B, Tai TW, Liang KW, Wang CK, Liu YS, Huang MT, Chang CW. Short-Term Effects of Genicular Artery Embolization on Symptoms and Bone Marrow Abnormalities in Patients with Refractory Knee Osteoarthritis. J Vasc Interv Radiol 2023; 34:1126-1134.e2. [PMID: 36889435 DOI: 10.1016/j.jvir.2023.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE To evaluate the short-term outcomes of genicular artery embolization (GAE) for knee osteoarthritis (OA) with and without bone marrow lesion (BML) and/or subchondral insufficiency fracture of the knee (SIFK). MATERIALS AND METHODS This single-institution prospective observational pilot study analyzed 24 knees in 22 patients with mild to moderate knee OA, including 8 knees without BML, 13 knees with BML, and 3 knees with both BML and SIFK. The area and volume of BMLs on magnetic resonance images were measured before and after GAE. Baseline and postoperative pain and physical function were assessed using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS GAE significantly reduced the BML area and volume 3 months after embolization in the knees with BML (both P < .0005). GAE significantly decreased the VAS scores at 3 and 6 months after embolization in patients without BML (both P = .04) and those with BML (both P = .01). GAE also lowered the WOMAC scores 3 months after embolization in patients without and with BML (P = .02 and P = .0002, respectively). However, GAE did not significantly alter the BML area and volume (both P = .25), VAS scores (P = 1.00), and WOMAC scores (P = .08) in patients with BML and SIFK at 3 months after GAE. CONCLUSIONS This observational pilot study suggested that GAE effectively reduces the BML area and volume and improves pain and physical function in patients with knee OA accompanied by BML but is inefficacious in those with both BML and SIFK.
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Affiliation(s)
- Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Ta-Wei Tai
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Biocompatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Kuo Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Tung Huang
- Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Wei Chang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Crema MD, Guermazi A, Roemer FW. Joint interventions in osteoarthritis. Skeletal Radiol 2023; 52:923-931. [PMID: 35982273 DOI: 10.1007/s00256-022-04150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is among the most common diseases affecting both axial and appendicular joints and the lead cause of disability worldwide. OA incidence is rising due to extended life expectancy and the increasing obesity epidemic. Several joint interventions are available to manage pain and joint function in patients with OA, most of these treatments being widely applied using intra-articular injections. In this chapter, we will describe the different joint interventions available for the management of pain in OA focusing on intra-articular injections, including discussion on the evidence regarding the efficacy of these treatments, based on the most recent systematic reviews and meta-analyses available. We also discuss the importance of imaging in guiding these treatments, including the different imaging modalities available for intra-articular injection guidance, their advantages, and disadvantages. Finally, we briefly discuss safety data and the consensus regarding the most used intra-articular treatments to manage pain in OA.
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Affiliation(s)
- Michel D Crema
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), 11 avenue du Tremblay, 75012, Paris, France.
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA.
| | - Ali Guermazi
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, West Roxbury, MA, USA
| | - Frank W Roemer
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Bhatia A, Bhatia S. The short-to-midterm outcomes of geniculate artery embolization for mild-to-moderate osteoarthritis of the knee: a systematic review. J Orthop 2023; 39:30-41. [PMID: 37089623 PMCID: PMC10114183 DOI: 10.1016/j.jor.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 03/19/2023] [Indexed: 04/25/2023] Open
Abstract
Background Geniculate Artery Embolization (GAE) is a novel, minimally-invasive treatment for mild to moderate Osteoarthritis (OA) associated with musculoskeletal pain. Purpose To investigate the outcomes of GAE in patients with mild to moderate OA of the knee using a Quantitative-analysis of the available literature. Methods The PubMed, EMBASE and Cochrane databases were searched for GAE-related studies. Qualitative and quantitative analyses were performed following PRISMA-guidelines. Quantitative-analysis was performed using windows based 'MedCalc-Statistical-Software version 19.6.1 (2020). Statistical analysis was performed in Stata-IC-13.1(Stata corp-USA). Quantitative-analysis was done using the random-effects model, and the Standardized-Mean-Differences (SMD) were calculated. Results After a full-text review, 13 studies with 399 knees (345-patients) were included in the qualitative synthesis, 10 were included in the quantitative synthesis. The total WOMAC score improved by a [SMD (95% CI)] of 3.46 points (1.27, 5.65), 3.50 (1.28, 5.71), 3.77 (0.58, 6.96), 5.46 (1.59, 9.33), 2.96 (-0.93, 6.85) compared to baseline at 1, 3, 6, 12, 24 months respectively. The VAS score improved by 2.06 (1.35, 2.76), 2.13 (1.39, 2.87), 2.36 (1.85, 2.90), 2.09 (0.91, 3.28) compared to baseline at 1, 3, 6, 12 months respectively. The Pain WOMAC score improved by SMD 2.97 (0.51, 5.43), 3.77 (0.58, 6.96), 2.27 (0.31, 4.22), 2.27 (0.31, 4.22) compared to baseline at 1, 3, 12, 24 months, respectively. Conclusion There was a statistically significant change from baseline in all outcome measures after GAE. GAE is a safe and effective method for pain control in mild to moderate OA-associated knee pain in the short and medium term.
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Affiliation(s)
- Ansh Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, MH, India
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Epelboym Y, Mandell JC, Collins JE, Burch E, Shiang T, Killoran T, Macfarlane L, Guermazi A. Genicular Artery Embolization as a Treatment for Osteoarthritis Related Knee Pain: A Systematic Review and Meta-analysis. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03422-0. [PMID: 36991094 DOI: 10.1007/s00270-023-03422-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Genicular artery embolization (GAE) is a minimally invasive therapy for symptomatic osteoarthritis (OA) in patients with knee pain refractory to conservative management. The purpose of this study was to evaluate evidence on the effectiveness of GAE for OA related knee pain as part of a systematic review and meta-analysis. MATERIALS AND METHODS Using Embase, PubMed, and Web of Science, a systematic review was performed to identify studies evaluating treatment of knee OA with GAE. The primary outcome measure was change in pain scale score at 6 months. A Hedge's g was computed as a measure of effect size, selecting Visual Analog Scale (VAS) first if available and Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index if VAS was not available. RESULTS After screening titles, abstracts, and the full text, 10 studies met inclusion criteria. A total of 351 treated knees were included. Patients who underwent GAE demonstrated declines in VAS pain scores at 1 month {- 34 points [95% CI (- 43.8, - 24.6)], 3 months {- 30 points [95% CI (- 41.7, - 19.2)], 6 months {- 41 points [95% CI (- 54.0, - 27.2)], and 12 months {- 37 points [95% CI (- 55.0, - 18.1)]. Hedges' g from baseline to 1, 3, 6, and 12 months, was {- 1.3 [95% CI (- 1.6, - 0.97)]}, {- 1.2 [95% CI (- 1.54, - 0.84)]}, {- 1.4 [95% CI (- 2.1, - 0.8)]}, and {- 1.25 [95% CI (- 2.0, - 0.6)]}, respectively. CONCLUSION GAE provides durable reductions in pain scores for patients suffering with mild, moderate, and severe OA.
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Affiliation(s)
- Yan Epelboym
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ezra Burch
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Tina Shiang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy Killoran
- Division of Angiography and Interventional Radiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Lindsey Macfarlane
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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Landers S, Hely R, Hely A, Harrison B, Page RS, Maister N, Gwini SM, Gill SD. Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial. Bone Jt Open 2023; 4:158-167. [PMID: 37051829 PMCID: PMC10032233 DOI: 10.1302/2633-1462.43.bjo-2022-0161.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
This study investigated the effects of transcatheter arterial embolization (TAE) on pain, function, and quality of life in people with early-stage symptomatic knee osteoarthritis (OA) compared to a sham procedure. A total of 59 participants with symptomatic Kellgren-Lawrence grade 2 knee OA were randomly allocated to TAE or a sham procedure. The intervention group underwent TAE of one or more genicular arteries. The control group received a blinded sham procedure. The primary outcome was knee pain at 12 months according to the Knee injury and Osteoarthritis Outcome Score (KOOS) pain scale. Secondary outcomes included self-reported function and quality of life (KOOS, EuroQol five-dimension five-level questionnaire (EQ-5D-5L)), self-reported Global Change, six-minute walk test, 30-second chair stand test, and adverse events. Subgroup analyses compared participants who received complete embolization of all genicular arteries (as distinct from embolization of some arteries) (n = 17) with the control group (n = 29) for KOOS and Global Change scores at 12 months. Continuous variables were analyzed with quantile regression, adjusting for baseline scores. Dichotomized variables were analyzed with chi-squared tests. Overall, 58 participants provided questionnaire data at 12 months. No significant differences were found for the primary and secondary outcomes, with both groups improving following the procedure. At 12 months, KOOS pain scores improved by 41.3% and 29.4% in the intervention and control groups, respectively. No adverse events occurred. Subgroup analysis indicated that the complete embolization group had significantly better KOOS Sports and Recreation, KOOS Quality of Life, and Global Change scores than the control group; 76.5% of participants who received complete embolization reporting being moderately or much better compared to 37.9% of the control group. TAE might produce benefits above placebo, but only when complete embolization of all genicular arteries is performed. Further comparative studies are required before definitive conclusions regarding the effectiveness of TAE can be made. Level of evidence: I.
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Affiliation(s)
- Steve Landers
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Rachael Hely
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Andrew Hely
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Benjamin Harrison
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
| | - Richard S Page
- Department of Orthopaedics, Barwon Health, Geelong, Australia
- Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University & St John of God Hospital, Geelong, Australia
| | - Nick Maister
- Department of Orthopaedics, Barwon Health, Geelong, Australia
| | | | - Stephen D Gill
- Barwon Medical Imaging, University Health Geelong, Geelong, Australia
- GIRADI Research Institute, Geelong, Australia
- Barwon Centre for Orthopaedic Research and Education (B-CORE), School of Medicine, Deakin University & St John of God Hospital, Geelong, Australia
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Lynskey SJ, Macaluso MJ, Gill SD, McGee SL, Page RS. Biomarkers of Osteoarthritis—A Narrative Review on Causal Links with Metabolic Syndrome. Life (Basel) 2023; 13:life13030730. [PMID: 36983885 PMCID: PMC10051744 DOI: 10.3390/life13030730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
Development of OA (OA) is multifactorial and is strongly associated with risk factors such as aging, trauma, metabolic disorders, and obesity. Metabolic Syndrome (MetS)-associated OA, collectively coined MetS-OA, is an increasingly recognized entity in which metabolic disorders and low-grade inflammation play a key mechanistic role in the disruption of joint homeostasis and cartilage degradation. Although there have been enormous efforts to discover biomarkers of MetS and OA, studies investigating a pathophysiological link between MetS and OA are relatively limited, and no serum blood marker has proved diagnostic so far. OA biomarkers that are necessary to discriminate and diagnose early disease remain to be elicited, explained in part by limited prospective studies, and therefore limited tools available to utilize in any prognostic capacity. Biomarker validation projects have been established by the Biomarker Consortium to determine biochemical markers demonstrating predictive validity for knee OA. Given that the metabolic constituents of MetS are treatable to varying extents, it stands to reason that treating these, and monitoring such treatment, may help to mitigate deleterious links with OA development. This narrative review will describe the current state of biomarker identification and utility in OA associated with MetS. We discuss the pathophysiological mechanisms of disease according to constituent pathologies of MetS and how identification of biomarkers may guide future investigation of novel targets.
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Affiliation(s)
- Samuel James Lynskey
- Department of Orthopaedic Surgery, Geelong University Hospital, Geelong, VIC 3220, Australia
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia
- Barwon Health Laboratory, Barwon Health, University Hospital Geelong, Geelong, VIC 3220, Australia
- Correspondence:
| | - Marc Julian Macaluso
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia
| | - Stephen D. Gill
- Department of Orthopaedic Surgery, Geelong University Hospital, Geelong, VIC 3220, Australia
- Barwon Centre for Orthopaedic Research and Education (BCORE), St. John of God Hospital, Deakin University, Barwon Health, Geelong, VIC 3220, Australia
- IMPACT—the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Sean L. McGee
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Geelong, VIC 3216, Australia
- IMPACT—the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Richard S. Page
- Department of Orthopaedic Surgery, Geelong University Hospital, Geelong, VIC 3220, Australia
- Barwon Centre for Orthopaedic Research and Education (BCORE), St. John of God Hospital, Deakin University, Barwon Health, Geelong, VIC 3220, Australia
- IMPACT—the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
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Sterbis E, Casadaban L. Genicular Artery Embolization Technique. Tech Vasc Interv Radiol 2023; 26:100878. [PMID: 36889843 DOI: 10.1016/j.tvir.2022.100878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Genicular artery embolization (GAE) is a safe and effective treatment for knee pain related to osteoarthritis, however there are several aspects of the procedure technique which may be unique. Familiarity with procedural steps, arterial anatomy, embolic endpoints, technical challenges, and potential complications is imperative for good clinical practice and outcomes. The success of GAE depends on correctly interpreting angiographic findings and variable anatomy, navigating small and acutely angled arteries, recognizing collateral supply, and avoiding non-target embolization. The procedure can potentially be performed for a wide range of patients with knee osteoarthritis. When effective, pain relief can be durable for many years. When done meticulously, adverse events from GAE are uncommon.
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Affiliation(s)
- Emily Sterbis
- Department of Radiology, Division of Interventional Radiology, University of Colorado. Anschutz Medical Campus, Aurora, CO
| | - Leigh Casadaban
- Department of Radiology, Division of Interventional Radiology, University of Colorado. Anschutz Medical Campus, Aurora, CO.
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O'Grady AM, Little MW. Genicular Artery Embolization Data Review. Tech Vasc Interv Radiol 2023; 26:100880. [PMID: 36889838 DOI: 10.1016/j.tvir.2022.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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!
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Affiliation(s)
- Aiden M O'Grady
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Mark W Little
- University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK.
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Talaie R, Torkian P, Golzarian J. Knee and Shoulder Vascular Anatomy. Tech Vasc Interv Radiol 2023; 26:100877. [PMID: 36889840 DOI: 10.1016/j.tvir.2022.100877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the past decade, angiographic studies have demonstrated neovessels in or in the vicinity of affected joints in many musculoskeletal conditions that used to be considered wear and tear joint disease, such as knee osteoarthritis, frozen shoulder, and overuse injuries. The novelty of this finding is showing the presence of neovascularity at an angiographically detectable level, as compared to histologically evident neovessels that had been discovered years ago. These neovessels have now become the target of interventions in a growing field called muscoskeletal embolotherapy. An in-depth and all-encompassing understanding of the vascular anatomy that could specifically assist performing of these procedures is paramount. Such an understanding will help ensure success in clinical outcomes and avoid much dreaded complications. This review discusses the vascular anatomy relevant to the 2 most commonly performed musculoskeletal embolotherapies, genicular artery embolization and transarterial embolization for frozen shoulder.
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Affiliation(s)
- Reza Talaie
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
| | - Pooya Torkian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN.
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Shaker M, Mahmoud MSS, Nassar WAM, Elshimy A, Nasser HM. Role of geniculate artery embolization in the treatment of knee pain secondary to osteoarthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Osteoarthritis (OA) is a leading cause of chronic knee pain and disability with a reported prevalence of 25–30% of the population. Knee OA has traditionally been thought as a degenerative disease only related to chronic repetitive injury “wear and tear” mechanism, yet it is now considered as a much more complex disease of inflammatory nature induced by cytokines and inflammatory mediators through abnormal neo-vascularization (angiogenesis). The rational of geniculate artery embolization (GAE) is based on the hypothesis that suggesting a direct relationship between the abnormal angiogenesis and the chronic knee pain. As a novel treatment option based on occlusion of these abnormal neo-vessels via geniculate artery embolization, we postulated that such a mechanism will relieve pain and improve the quality of life. GAE has been previously approved as a safe and effective treatment in cases of post-knee arthroplasty hemarthrosis.
Purpose
To evaluate the feasibility, safety, and efficacy of geniculate artery embolization for OA-related knee pain.
Materials and methods
Sixteen patients with knee pain secondary to chronic OA refractory to conservative therapies for at least 6 months and not yet fit for total knee replacement were enrolled in a prospective single arm interventional study. GAE was performed using 150–300 μm microspheres. Patients were assessed and followed up using the visual analogue scale (VAS) for pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for the overall knee function at baseline and at 1 week, 1, 3, and 6 months post-embolization.
Results
A total 16 patients presented by knee pain secondary to chronic OA were enrolled. All of them showed a remarkable improvement in the VAS and WOMAC scores, with better clinical outcome after GAE. Pre- versus post-embolization ± MDs in VAS score from 8.38 ± 0.81 (baseline) to 2.88 ± 1.54 after 6 months (post-embolization) equivalent to 66.66% improvement. There was also a satisfactory improvement in the WOMAC scores, with ± MDs drop from 77.94 ± 10.62 (baseline) to 49.69 ± 15.43 (post-embolization) equivalent to 37.41% improvement. No severe or life-threatening complications were reported.
Conclusions
GAE holds promise as an effective minimally invasive procedure for the treatment of knee pain secondary to OA and could be introduced as a safe technique with no serious complications.
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Taslakian B, Miller LE, Mabud TS, Macaulay W, Samuels J, Attur M, Alaia EF, Kijowski R, Hickey R, Sista AK. Genicular artery embolization for treatment of knee osteoarthritis pain: Systematic review and meta-analysis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100342. [PMID: 36865988 PMCID: PMC9971280 DOI: 10.1016/j.ocarto.2023.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Objective Genicular artery embolization (GAE) is a novel, minimally invasive procedure for treatment of knee osteoarthritis (OA). This meta-analysis investigated the safety and effectiveness of this procedure. Design Outcomes of this systematic review with meta-analysis were technical success, knee pain visual analog scale (VAS; 0-100 scale), WOMAC Total Score (0-100 scale), retreatment rate, and adverse events. Continuous outcomes were calculated as the weighted mean difference (WMD) versus baseline. Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) rates were estimated in Monte Carlo simulations. Rates of total knee replacement and repeat GAE were calculated using life-table methods. Results In 10 groups (9 studies; 270 patients; 339 knees), GAE technical success was 99.7%. Over 12 months, the WMD ranged from -34 to -39 at each follow-up for VAS score and -28 to -34 for WOMAC Total score (all p < 0.001). At 12 months, 78% met the MCID for VAS score; 92% met the MCID for WOMAC Total score, and 78% met the SCB for WOMAC Total score. Higher baseline knee pain severity was associated with greater improvements in knee pain. Over 2 years, 5.2% of patients underwent total knee replacement and 8.3% received repeat GAE. Adverse events were minor, with transient skin discoloration as the most common (11.6%). Conclusions Limited evidence suggests that GAE is a safe procedure that confers improvement in knee OA symptoms at established MCID thresholds. Patients with greater knee pain severity may be more responsive to GAE.
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Affiliation(s)
- Bedros Taslakian
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, NY, United States,Corresponding author. Clinical assistant Professor of Radiology, NYU Grossman School of Medicine; Director of VIR Research Program, Interventional Radiology Section; Director of Clinical Research Integration, Department of Radiology, NYU Langone Health, New York, NY, United States.
| | | | - Tarub S. Mabud
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, NY, United States
| | - William Macaulay
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, United States
| | - Jonathan Samuels
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, United States
| | - Mukundan Attur
- Division of Rheumatology, Department of Medicine, NYU Langone Health, New York, NY, United States
| | - Erin F. Alaia
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Richard Kijowski
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Ryan Hickey
- Division of Vascular and Interventional Radiology, Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Akhilesh K. Sista
- Division of Vascular and Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, NY, United States
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Two-year outcomes comparing Embosphere® microspheres versus Imipenem Cilastatin for genicular artery embolization in patients with moderate to severe knee osteoarthritis. Knee 2023; 41:38-47. [PMID: 36608360 DOI: 10.1016/j.knee.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/06/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Genicular artery embolization (GAE) is a novel technique and has the potential to provide midterm relief of pain for patients with mild-to-moderate knee osteoarthritis resistant to conservative management. This study compares the efficacy and safety of trisacryl gelatin microspheres to Imipenem/Cilastatin particles for GAE with 2 years of clinical follow-up. METHODS In this retrospective study, eight patients with knee osteoarthritis (11 knees) who underwent GAE with 100-300 μm trisacryl gelatin microspheres particles were compared with six patients (nine knees) who underwent GAE with Imipenem/Cilastatin particles. Clinical outcomes were evaluated at 3-month and 24-month follow-ups and compared to baseline using the WOMAC questionnaire. RESULTS The median follow-up was 796 days (range: 736-808). There were no significant differences in clinical outcome measures at the 3-month or 24-month follow-up. Both embolic materials resulted in a decrease in Pain WOMAC and Total WOMAC scores at 3 months (p < 0.05), and the effect of treatment on Pain WOMAC and Total WOMAC score reduction was sustained until the 24-month follow-up (p < 0.05). Minor events (Clavien-Dindo classification grade I) included transient cutaneous color change (n = 3) and transient leg numbness (n = 1) after embolization with trisacryl gelatin microspheres particles (p = 0.08). All minor adverse events resolved spontaneously. There were no major adverse events. CONCLUSION One hundred to three hundred μm trisacryl gelatin microspheres particles can be considered for genicular artery embolization and is comparable to Imipenem/Cilastatin particles in pain reduction of moderate to severe knee osteoarthritis. A sustained effect is observed for up to 2 years of follow-up.
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