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