Genicular Artery Embolization: A Technical Review of Anatomy, Pathophysiology, Current Experiences, and Future Directions.

Abstract

Genicular artery embolization (GAE) is an emerging minimally invasive procedure for managing knee osteoarthritis (OA), a condition affecting 365 million individuals globally. Initially developed to treat hemarthrosis, GAE selectively embolizes abnormal genicular vasculature, targeting synovial inflammation and reducing neoangiogenesis. This process alleviates pain and improves joint function, providing an alternative for patients with mild-to-moderate OA who are not candidates for surgical interventions due to comorbidities or other factors. Current evidence supports the use of GAE for patients with mild-to-moderate OA who experience persistent symptoms despite conservative treatments such as physical therapy, weight management, or intra-articular injections. The procedure effectively reduces pain, improves functionality, and provides sustained benefits. This review highlights the anatomical principles, procedural techniques, and patient selection criteria for GAE, as well as the clinical evidence supporting its safety and efficacy. It also explores potential future directions for research, including optimizing patient selection, evaluating long-term outcomes, and integrating GAE into routine OA management pathways.