Maggie McKay (Host): Welcome to Answers In Vascular, a podcast from the Vascular Care Group. Today we'll find out what Genicular Artery Embolization is and how it may be able to help you with Board Certified Vascular Surgeon, Dr. Chong Li. I'm your host, Maggie McKay. Thank you so much for joining us today, Dr. Li.

Chong Li, MD, RPVI: Thank you for having me. It's my pleasure to do this with you, Maggie.

Host: So what is Genicular Artery Embolization and how does it work for knee pain relief?

Chong Li, MD, RPVI: Genicular artery embolization or the acronym GAE is a minimally invasive procedure designed to relieve knee pain caused by osteoarthritis. It works by reducing blood flow to certain area of the knee, which help decrease inflammation and pain. Unlike surgery, GAE does not involve cutting into the knee or replacing any joints. It simply targets the tiny blood vessels that contribute to the pain process and the inflammation.

Maggie McKay (Host): Is it a shot, like a cortisone shot?

Chong Li, MD, RPVI: It's a shot within the artery. It's not a shot from outside the skin. Basically, we use the vascular route, the arterial route that we are so used to do by treating other pathologies like peripheral artery disease and we simply target the painful area in the knee and shut off the inflammation contributed by the blood vessel growth.

Host: Who is the ideal candidate for this procedure.

Chong Li, MD, RPVI: So, this procedure is best for individuals with moderate to severe knee pain due to osteoarthritis who has not found relief with treatments that are more conservative or standard like physical therapy, pain medication, or injection as you mentioned. It is also great option for people who are not ready or cannot undergo knee replacements such as too old or too obese and whatnot.

However, it might not be suitable for patient with certain conditions such as severe vascular problems, such as peripheral arterial disease or active infection.

Host: Can you walk us through the day of the procedure? What can patients expect?

Chong Li, MD, RPVI: So patient can expect a smooth outpatient experience as we have done it and matured this technique in our practice. Here's a step by step of what it looks like the day, that might involve. First check in and preparation. Upon arrival, our medical team will review your health history and confirm details.

You'll change into a gown and we'll place an IV in your vein for administering anesthetic and blood thinning medications. The procedure usually takes about 30 to 45 minutes. The patient will have a mild sedation and local anesthesia as the procedure is relatively quick and not painful. Once the catheter's removed, once the procedure is concluded, a small bandaid will be placed at the access site, usually is in the upper thigh. Patient typically rests for a short period, like 30 or 45 minutes before going home the same day.

Host: That is amazing. I mean, how easy could it be? What are the steps involved in performing the actual procedure itself?

Chong Li, MD, RPVI: So just to break down the procedure more in a little more detail. At first I administer local anesthesia at the needle puncture site. That's how I get into the artery. Unlike major surgeries, the person will not be put to sleep instead, we'll numb the small area on the upper thigh or groin.

And then we use imaging guidance to guide our small catheter into the painful area in the knee along the arterial route. So using specialized X-ray technology we'll carefully guide a small catheter or a thin tube, almost like the diameter of a toothpick into the small artery supply in the knee. We look for abnormal blood vessel growth that corresponds to the inflammation and the pain and the perfusion, which guides us to say Hey, this is the painful area and this is the right area to embolize or basically shut off the abnormal blood supply. And then once we're in that area, we instill tiny particles, injecting into these abnormal arteries to reduce the excessive blood flow and inflammation. And this procedure, this process is called embolization. At the conclusion, using x-ray and imaging guidance, we ensure that this abnormal blood perfusion are decreased around the knee, especially the painful area.

And afterwards, we take out the catheter and leave nothing behind. And then we just hold some pressure at the puncture site to achieve hemostasis, stopping the bleeding.

Host: What's the typical recovery process like after genicular artery embolization? Because you mentioned people go home the same day, it's a few hours. What's the full recovery? How long does that take?

Chong Li, MD, RPVI: Yeah, for sure. It's a same day discharge for all this procedure. All patient go home. Again, the procedure takes about 30 to 45 minutes, and we usually watch a person for another 45 minutes. So people probably go from check in to leaving for home in two to two and a half hours. There's minimal downtime. 

Someone might expect mild soreness at the access site, or sometimes the knee might hurt for a little bit more before it gets better. But it commonly resolves within a few days and most people can return to normal activity usually within 24 to 48 hours. The pain relief sometimes comes right away, sometimes takes a few days, and it will continue to improve over the next few months.

And we usually see people back in about two or three weeks, make sure the pain is relieved, that they're having a good outcome, and we track patient this way and have them fill in some pain scoring sheet and go from there.

Host: So is this forever? Does it last forever, or do you have to eventually get surgery?

Chong Li, MD, RPVI: Yeah, sure. So the data, and from my anecdotal experience is that it lasts quite a while. It can range from six months, which is on a shorter time to up to two or three years. For two or three years relief, for someone who are especially elderly, not a candidate for knee replacement, that can seem like a lifetime.

Host: What can a patient expect? I know you touched on it a little bit, as far as the outcome. What does the latest data say about its effectiveness?

Chong Li, MD, RPVI: Sure. So the latest data and all the studies put together show that the GAE can significantly reduce knee pain for many patients, especially moderate to severe pain, with improvement lasting up to two or three years. While it may not completely eliminate pain, it usually allows people to delay or avoid knee surgery and dramatically improve quality of life and also reduce the amount of medication or injection that they need.

More recent research suggests that about 80% of the patients can experience meaningful pain relief within the first few months after the procedure, and that the pain relief and decrease for pain can again, last up to years.

Host: So how did you learn and become proficient with this technique as a vascular surgeon?

Chong Li, MD, RPVI: Yeah. Thank you for that question. So interestingly, in our community down here in Connecticut, a lot of folks, especially with vascular disease are more elderly compared to some other urban areas. A lot of people come in with concurrent knee arthritis and, you know, you treat their such as venous disease or peripheral arterial disease, but their leg is still hurting.

And having known that the technique of GAE provides great lasting outcomes, we as a group picked that up. We learned from the few other interventional radiologists who are performing this procedure and now we have applied it to our patients, matured the techniques, and are providing patients another durable relief for their leg pain and knee pain.

Host: It's so great to have an option besides surgery.

I mean,

Chong Li, MD, RPVI: Absolutely.

Host: this doesn't really count as surgery, right? I mean, I know you're getting anesthetic, but and it's anesthesia.

Chong Li, MD, RPVI: Yeah, it, right, it's technically is a procedure. When you say surgery, people imagine you are having to open up their knee. But this is a minimally invasive technique, endovascular technique, that you know, only takes less than an hour and takes a couple hours of a patient's day and can provide very meaningful outcome.

Host: I love that. Is there anything else in closing that you'd like to add that we didn't discuss?

Chong Li, MD, RPVI: Yeah. So, you know, we treat a wide array of patients within our population. You know, people with vascular conditions have, they're pretty el elderly. They're pretty much all have multiple comorbidities, diabetes, high blood pressure, and being able to treat their knee pain concurrently while managing the other vascular issues and treating a patient's leg pain holistically, it's very meaningful and we're happy to see that this technique has great outcomes that are that lasting and we're happy to provide this as a another option to treat people with knee pain and leg pain.

Host: And I bet they're so grateful to you to have this option. Thank you so much for sharing this useful information. We appreciate you.

Chong Li, MD, RPVI: Thank you very much, Maggie. Happy to do this again.

Host: That'd be great. Again, that's Dr. Chong Li. To find out more, please call 866-3VASCULAR or visit the vascularcaregroup.com to see if GAE is right for you. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to Answers in Vascular a podcast from the Vascular Care group.