Ep. 535 Genicular Artery Embolization: Current Controversies and Insights with Dr. Sid Padia and Dr. Osman Ahmed
Apr 22, 2025
01:26:54
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Quick takeaways
Long-term data is essential for establishing genicular artery embolization (GAE) as a credible, lasting alternative for managing knee pain.
Patient selection remains complex, with MRI offering potential insights into eligibility, but its diagnostic reliability is still debated.
The choice of access route for GAE, whether femoral or pedal, is influenced by patient factors and operator preference, highlighting individualized approaches.
Deep dives
The Value of Long-Term Data in Genicular Artery Embolization
Long-term data is crucial in genicular artery embolization (GAE) as it provides insights into the durability of patient outcomes. Emphasizing a duration of response measured in years rather than weeks or months strengthens the credibility of the procedure both for the medical community and patients. This long-term perspective allows healthcare providers to communicate more effectively and establishes GAE not as a temporary solution, but as a lasting alternative for managing pain in patients with knee issues. By advocating for comprehensive follow-up, practitioners can promote GAE as a viable treatment option backed by robust data.
MRI and Patient Selection for GAE
Patient selection is a critical challenge in GAE, with current discussions centering on the role of MRI in identifying candidates. Some experts argue that MRI can provide valuable information such as the presence of bone marrow lesions or synovial thickening, which could predict procedural success. However, there is skepticism about the ability of MRI findings to reliably forecast who will respond favorably to GAE, as existing studies yield mixed results. Overall, while there is potential for MRI to improve patient selection, its use as a diagnostic tool remains largely investigational at this stage.
Access Techniques: Pedal vs. Femoral Access
The choice of access route for GAE is debated, with differing opinions on whether femoral or pedal access is superior. Advocates of femoral access argue that it provides better visualization and easier access to genicular arteries, particularly in patients with typical anatomies. Conversely, proponents of pedal access suggest it may be advantageous in select patient populations, especially those with poor femoral access. Ultimately, both techniques have their advocates, emphasizing that the choice may depend on individual patient factors and operator preference.
The Use of Cone Beam CT in GAE Procedures
Cone beam CT is considered a useful tool during GAE procedures, allowing for better visualization of vascular anatomy. It enhances the identification of target arteries, which can significantly improve procedural efficiency and accuracy. However, some practitioners remain cautious about its routine use, arguing that experienced operators may not find it necessary once they are familiar with the anatomy. While the incorporation of cone beam CT may add valuable information, its status as a standard practice remains subject to ongoing evaluation and discussion within the interventional radiology community.
Post-Operative Follow-Up and Patient Outcomes
Patient follow-up after GAE is essential to assess both subjective and objective outcomes, yet varying lengths of follow-up can be debated. While some argue that shorter follow-ups may miss chronic changes in patient conditions, others emphasize the practicality and resource constraints of conducting longer-term studies. The length of patient follow-up often depends on factors such as clinic capacity and patient willingness to return. Ultimately, a balanced approach that considers the need for ongoing evaluation alongside practical limitations is crucial for enhancing patient care.
The Role of Repeat GAE in Long-Term Pain Management
The discussion around repeat GAE centers on its appropriateness for patients who have seen initial success followed by symptom recurrence. While some argue for the potential benefits of re-embolization in those experiencing new or returning symptoms after an initial positive outcome, others caution against offering it to patients whose responses were marginal. Identifying true responders and structuring follow-up to ensure patients are appropriately evaluated helps in determining the value of repeat procedures. Therefore, repeat GAE may be warranted in select cases, but should be approached with careful consideration.
Who is the ultimate candidate for GAE, which technical approach is best, and how do you set your patients up for success? Tune into this week’s episode of BackTable to hear from interventional radiologists Dr. Osman Ahmed (University of Chicago Medicine) and Dr. Siddharth Padia (UCLA Health) as they discuss everything from patient selection to follow-up care, covering pre-procedure imaging, access, embolics, technical challenges, clinical data, and the future of genicular artery embolization.
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SYNPOSIS
Dr. Ahmed and Dr. Padia debate their approaches to patient selection criteria, the use of MRI and cone beam CT, permanent vs. resorbable embolic materials, how many arteries to embolize, and the relevance of pain metrics post GAE. They also delve into follow-up considerations and the potential for GAE as a long term treatment.
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TIMESTAMPS
00:00 Introduction
01:08 MRI for Patient Selection in GAE
08:53 Access Techniques: Femoral vs. Pedal
17:07 Cone Beam CT in GAE Procedures
27:20 Embolization Strategies
39:30 Challenges and Complications in Embolization
44:50 Follow-Up and Pain Metrics in Clinical Practice and Research
