Genicular artery embolization (GAE) is a newer, minimally invasive procedure for knee pain caused by osteoarthritis. It is meant for people whose pain has not improved enough with exercise, physical therapy, medicines or injections. GAE does not replace a worn-out joint or repair cartilage. Its goal is to calm the inflamed lining of the knee and reduce pain. It is not right for everyone.
The vascular surgeons of Vascular & Vein Institute of the South (VVIS) evaluate patients for GAE and perform the procedure. We see patients at our offices across Tennessee, Mississippi and Arkansas. Call 901-390-2930 or schedule online.
What is genicular artery embolization?
Osteoarthritis is often called “wear-and-tear” arthritis, but inflammation of the joint lining is part of the problem. Over time, the cartilage that cushions the knee wears down, and the lining of the joint (the synovium) can become inflamed. Inflamed tissue grows extra tiny blood vessels. Researchers think these vessels, and the nerves that grow along with them, add to knee pain.
The genicular arteries are small arteries that supply the knee. In GAE, a vascular surgeon places a thin tube (catheter) into an artery, usually in the groin, and guides it to these small arteries using X-ray images. Tiny particles are then released to reduce blood flow to the abnormal vessels in the inflamed lining. The main arteries of the leg are not blocked.
GAE is done through a needle puncture, not a surgical cut, so there are no stitches. Most people go home the same day.
Signs and symptoms of knee osteoarthritis
Knee osteoarthritis can cause:
- Aching pain that gets worse with walking, climbing stairs or standing for a long time
- Stiffness, especially in the morning or after sitting
- Swelling around the knee
- A grinding or cracking feeling when the knee moves
- Trouble fully bending or straightening the knee
Pain from osteoarthritis usually builds slowly over months or years.
Go to an emergency room or urgent care the same day if your knee suddenly becomes red, hot and swollen, especially with a fever. That can mean a joint infection or another problem that needs treatment right away.
Causes of knee arthritis, and who may be a candidate for GAE
Knee osteoarthritis becomes more common with age. Other risk factors include:
- Extra body weight, which adds stress to the knee
- A past knee injury or knee surgery
- Work or sports with a lot of kneeling, squatting or heavy lifting
- A family history of arthritis
- Being female. Women develop knee osteoarthritis more often than men.
GAE may be an option if you:
- Have knee osteoarthritis confirmed on an X-ray or MRI
- Have had moderate to severe knee pain for at least 3 to 6 months
- Have tried conservative care, such as exercise, physical therapy, weight loss, pain medicines or injections, without enough relief
- Are not ready for, or are not able to have, knee replacement surgery
GAE is not the right choice if the painful knee has already been replaced, if there is an active infection in the knee or elsewhere in your body, or if the pain comes from another cause, such as a torn meniscus, a problem in the hip or back, or an inflammatory arthritis such as rheumatoid arthritis. Severe kidney disease, an allergy to X-ray dye, or blocked leg arteries may change how the procedure is planned, or whether it can be done safely.
How knee arthritis is diagnosed, and how we evaluate you for GAE
Your visit starts with a review of your symptoms, past treatments and overall health, and an exam of the knee. We review X-rays of the knee, ideally taken while you stand, which show how much joint space is left. Some people also need an MRI to look for other causes of pain.
Because GAE is done through the arteries, we also check the circulation in your legs. If you have signs of peripheral artery disease, an ultrasound may be done first.
Not sure where to start? Take our two-minute knee pain self-check to see whether GAE may be worth discussing.
Treatment options for knee osteoarthritis pain
Most people should start with conservative care. These steps help many people, and they stay important even if you later have GAE:
- Exercise and physical therapy to strengthen the muscles that support the knee
- Weight loss, if needed, to take stress off the joint
- Medicines, such as anti-inflammatory pills or creams, or acetaminophen, if they are safe for you
- A knee brace or a cane to ease the load on the knee
- Injections, such as steroid shots, which can give short-term relief
When these do not help enough, the next options include GAE and, for more advanced arthritis, knee replacement surgery by an orthopedic surgeon. Knee replacement is a well-established treatment for severe arthritis. GAE may appeal to people who are not ready for surgery, whose health makes surgery risky, or who want to try a less invasive step first. We will help you think through where GAE fits, and when an orthopedic opinion makes more sense.
What to expect: the GAE procedure and recovery
- Before. We confirm the diagnosis, review your imaging, and check your kidney function and medicines. Our team also checks your insurance. Coverage for GAE varies, and some plans consider it experimental and do not cover it.
- During. You are awake but relaxed with medicine given through an IV, and the skin at the puncture site is numbed. The procedure usually takes about one to two hours.
- After. You rest for a few hours so the puncture site can seal, then go home the same day. Most people walk the same day and return to light activity within a few days.
- Results. If GAE helps, relief usually comes on gradually over several weeks, not right away.
Risks are usually minor, such as bruising or soreness where the catheter went in. Some people notice a short-lived change in skin color over the knee. Rare problems include skin sores, numbness, damage to bone or other tissue near the knee, and reactions to the X-ray dye.
| GAE at a glance | |
|---|---|
| Anesthesia | Awake, with IV sedation and local numbing |
| Time | About 1 to 2 hours |
| Hospital stay | None; home the same day |
| Back to light activity | Within a few days |
| When relief appears | Builds over several weeks |
| Coverage | Varies by plan; some plans consider it experimental |
After the procedure, call us right away at 901-390-2930, day or night, if your foot turns cold, pale or numb. After hours, our answering service reaches the physician on call. If the puncture site bleeds, lie down and press firmly on it, and call 911 if the bleeding does not stop. Also call us right away if you have a growing lump at the puncture site, a fever, worsening knee pain, or a new skin sore over the knee.
When to see a vascular surgeon about knee pain
Consider an evaluation if knee arthritis pain limits your walking, sleep or daily life, you have tried conservative care for at least 3 months, and you are not ready for, or cannot have, knee replacement. Please bring any recent knee X-ray or MRI reports to your visit.
Frequently asked questions
Can GAE help me avoid knee replacement?
We do not know yet. GAE has not been shown to prevent or delay knee replacement, and it does not repair cartilage. For some people, less pain may make it easier to stay active. If your arthritis is severe, knee replacement may be the better long-term choice.
Is GAE painful? Will I be asleep?
Most people are awake but relaxed with IV sedation. The skin where the catheter goes in is numbed, so you should feel little more than pressure. Some people feel mild knee aching during or after the procedure. You usually go home the same day.
How long does relief last?
It varies. If GAE works for you, relief usually builds over several weeks. How long it lasts is still being studied, and some people get little or no benefit. Keeping up with exercise and weight control helps protect the knee either way.
What are the risks of GAE?
The most common are bruising or soreness where the catheter went in, and a short-lived change in skin color over the knee. Less common risks include skin sores, numbness, damage to bone or tissue near the knee, bleeding, and reactions to the X-ray dye. Serious problems are rare.
Does insurance cover GAE?
Coverage varies by plan. Some insurance plans consider GAE experimental and do not pay for it. Our team checks your coverage before a procedure is scheduled and will tell you what we find before you decide.
Can I have GAE if my knee was already replaced?
GAE, as we offer it, is for knees with osteoarthritis that have not been replaced. Pain after a knee replacement can have other causes, such as loosening, infection or scar tissue, and should be checked by your orthopedic surgeon first.
Why does a vascular surgeon perform GAE?
GAE is a procedure done inside the arteries. Vascular surgeons are trained to diagnose and treat artery problems, including with catheter-based procedures like this one. We also check the circulation in your legs as part of your evaluation.
How much does GAE cost if my insurance does not cover it?
Ask our team for an estimate before anything is scheduled. We check your coverage first and tell you what we find before you decide.
Can GAE be done on both knees?
Yes, when both knees qualify. Your surgeon will discuss whether to treat them in one session or separately.
Can GAE be repeated if the pain comes back?
Sometimes. If pain returns, a repeat procedure can be considered after new imaging. The evidence on repeat treatment is limited, and we will discuss it with you plainly.
If knee arthritis pain is keeping you from the life you want and other treatments have not helped enough, find out whether GAE may be an option for you. Call 901-390-2930 or schedule online.