Scott Webb (Host): Welcome to UK HealthCast, the podcast from UK HealthCare. I'm Scott Webb. And today, we're discussing genicular artery embolization with Dr. Merve Ozen. She's an interventional radiologist and she is going to explain how this safe and effective procedure might spare folks from having knee replacement surgery.

Doctor, thanks so much for your time today. This is a new topic for me. We're going to learn, listeners and myself, we're going to learn about genicular artery embolization or GAE. So sort of in layman's terms, what does that mean? How does that work?

Dr. Merve Ozen: Genicular artery embolization is a minimally invasive procedure that involves blocking or reducing blood flow to the genicular arteries, which are small blood vessels supplying the knee joint. And this procedure is performed to relieve the chronic knee pain in patients who are not suitable candidates for knee replacement surgery or who has persistent pain, swelling after knee surgery.

Before diving into the genicular artery embolization, I want to talk about osteoarthritis, especially knee osteoarthritis. Osteoarthritis is the most prevalent joint disease and a leading source of chronic pain and disability in the United States. And knee osteoarthritis accounts for more than 80% of the disease total burden and affects at least 19% of American adults age 45 years and older.

So, the studies show that knee osteoarthritis approximately caused by the breakdown of the joint tissues from mechanical loading, which causes inflammation. So, how does osteoarthritis affect our patient's daily lives? It causes pain, it causes stiffness, swelling. In some cases, it causes reduced function and disability, and patients are no longer able to do their daily tasks or works. And this ultimately impairs quality of life. And our goal with genicular artery embolization is reducing this inflammation, which will reduce the pain, and this will increase patient's quality of life using a minimally invasive procedure.

Host: Yeah. And as somebody in my 50s who suffers from osteoarthritis, I'm all ears today. So, how does it work? How does GAE work? You say it's minimally invasive. Maybe you can, in layman's terms, sort of explain that a little bit more.

Dr. Merve Ozen: Interventional radiology is a field that does procedures. We are the folks who don't do big surgeries, but we can do procedures that can treat cancers, block vessels and treat bleedings. So, we have these high-end devices that we call catheters and we have microcatheters. So going through the big vessels from the groin or from the wrist, we can insert very, very tiny catheters almost the size of a spaghetti, and go into these vessels into the knee. And then, we can inject these tiny particles. We do these procedures using ultrasound and x-ray guidance, and we also have the opportunity to see where this blood flow goes by using a CAT scan on the table during the procedure.

And this procedure is usually done on an outpatient basis, meaning patients come to the hospital and they can go home on the same day. And we usually give twilight, and we also have the opportunity to use general anesthesia in patients who can't tolerate twilight. Did that answer your question?

Host: Yeah, it did. And you mentioned earlier that GAE is really suitable for folks who maybe aren't suitable candidates for knee replacement surgery. So, maybe you can talk a little bit more about that in terms of who's a good candidate, who's a suitable candidate for genicular artery embolization.

Dr. Merve Ozen: GAE is typically considered for patients with chronic knee pain who have not responded well to conservative treatments such as medication, physical therapy or injections. It's also an option for patients who are not ideal candidates for knee replacement surgery due to factors like underlying health conditions or simply patient preference. And this is a newer procedure. The scientific data is increasing and it's getting better. We are having more and more information every day. So, we are very proud to have this procedure at the University of Kentucky.

Host: Yeah, I'm sure you are. And I mean, to me, you know, sort of a lay person, it sounds a little bit like science fiction. But you seem pretty comfortable and confident with this. So, just wondering if it's a safe procedure. Anything that folks should be concerned about?

Dr. Merve Ozen: GAE is considered as a safe procedure with a low risk of complications. Every procedure has a complication rate. But compared to other surgical procedures, the complication rate is much less. And it's a minimally invasive procedure. And we use x-ray and ultrasound to minimize these risks and to ensure accuracy.

And our goal is to maintain normal blood flow, but block the inflamed areas. And this requires a certain level of expertise. We do embolization procedure for different parts of the body, and we have a good experience in this type of procedure.

Host: Yeah, it's very cool. And as you mentioned earlier when you were talking about osteoarthritis, a lot of folks unfortunately suffer from this and they may not be a suitable candidate for knee replacement or their personal preference. They may choose GAE. So, talk a little bit about the success rate.

Dr. Merve Ozen: The success rate of GAE varies depending on the individual and the underlying cause of the knee pain. And the studies have shown significant pain reduction in most of the patients and with most of them have long lasting relief. However, every patient is different and the effectiveness of the procedure may vary.

Host: Yeah. And you said earlier that it's outpatient, of course, minimally invasive. So, folks, you know, they're in and out in the same day. What's the recovery process like once they get home?

Dr. Merve Ozen: We ask our patients not to do any strenuous activities or exercising involving the knee joint for a certain period of time. And for the access of the artery, we keep our patients from two to six hours, depending on our access right after the procedure. And they can go home on the same day. And for sedation, the recovery time doesn't exceed an hour.

Host: Assuming even though it's minimally invasive, which usually means for folks smaller scars, faster recovery times, less medication. But when we talk about the pain relief that folks may take post GAE, maybe tell us a little bit about that. What's involved, how long are they on things, and just generally what's the pain relief like?

Dr. Merve Ozen: The duration of pain relief can vary among patients. And the most recent scientific studies show long-lasting pain relief for months or even years. While some of the patients may require repeat procedures or additional treatments over time, but the main point is we need regular followup, with the interventional radiologists to assess the effectiveness of the procedure and to see if the patients need further interventions.

Host: Yeah, that's perfect. So, some followup is needed. They may still be on pain relief and we may have to go back in. But in general, it sounds like it's a fairly successful or very successful procedure for folks. And we sort of identified, you know, who might be suitable for this. As we wrap up here, doctor, and this has been really educational for me, again, as somebody who suffers from osteoarthritis, I'm all ears today. When folks are trying to find a healthcare provider, you said there's a level of expertise that's required. So in terms of finding someone who performs GAE besides yourself, what types of questions should folks be asking? What should they be in the lookout for and so on?

Dr. Merve Ozen: It's important to consult a qualified interventional radiologist. They can provide appropriate assessment like their pain levels, their expectations, and the procedure, location, if they have a CAT scan inside the procedure room because every procedure has its complications. And if you have a better technology, like here in the University of Kentucky, you can have better success rates.

And as interventional radiologists at the University of Kentucky, we follow the latest scientific developments and we have the latest technology and we contribute to these latest developments, and we are happy to offer that new therapy who will help a lot of people who has osteoarthritis in Kentucky using high-end fluoro procedure rooms and new devices.

One of the new devices that we have is called angio CT. So during the procedure when we do x-ray imaging, fluoro imaging, we can implement a CT device at the same time and take pictures of the area where we exactly inject into. And this is a very, very new device that is one of its kind. So, we are very happy to offer this procedure using this new technology. And our clinic is located on Limestone Street. The Interventional Radiology Clinic is a location that you can call and ask more information, and you can come and find us there to get more information about this procedure.

Host: Yeah, that's great. As folks may be weighing their options, if they have osteoarthritis, inflammation and they're trying to decide, knee replacement or genicular artery embolization, you know, just good to do their homework, ask questions. It's really great. You know, nice to meet you today. Nice to learn more about this procedure and what you do in there you at the University of Kentucky. Thanks so much.

Dr. Merve Ozen: Thank you so much for having me.

Host: And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate and review this podcast and all the other UK HealthCare podcasts. I'm Scott Webb. Stay well.