Medical Management of Patients with Osteoarthritis (OA) Prior to Genicular Artery Embolization (GAE)

Monday, March 6, 2023

5:50 PM – 5:55 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Mason Eghbali, BA

Medical Student
California University of Science and Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Caleb F. Solivio, BS (he/him/his)

Medical Student
California University of Science and Medicine
TS

Talha Shabbir, MS

Medical Student
California University of Science and Medicine
GV

Geogy Vatakencherry, MD, FSVM,FSIR

Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente physician
AB

Alok Bhatt, MD

Assistant Program Director of Vascular and Interventional Integrated Residency
Kaiser Permanente Los Angeles
Kartik Kansagra, MD

Vascular and Interventional Physician
KP VISLA

Disclosure(s):

Mason Eghbali, BA: No financial relationships to disclose

Caleb F. Solivio, BS: No financial relationships to disclose

Geogy Vatakencherry, MD FSIR: No financial relationships to disclose

Kartik Kansagra, MD: No financial relationships to disclose

Learning Objectives: 1. Understand the pathophysiology of osteoarthritis (OA).

2. Review the current treatment algorithm used for OA including lifestyle modifications, pharmacologic options, intra-articular injections, regenerative therapies, genicular artery embolization (GAE), and surgical interventions.

3. Discuss the growing use, indications, contraindications, and potential complications of GAE for the treatment of OA.

Background: Osteoarthritis is a non-inflammatory degenerative disorder of the synovial joints. It typically presents with joint pain, stiffness, and locomotor restriction, making it a leading cause of impaired function and disability {1}. The joint-specific management of OA includes nonpharmacologic lifestyle modifications, pharmacologic options, intra-articular injections, regenerative therapies, genicular artery embolization (GAE), and surgical options with the primary goal being to minimize pain, optimize function, and modify the process of joint damage {2}. Specifically, the severity of disease and patient's comorbidities must be considered when constructing a treatment plan. For example, mild knee OA treatment should focus on nonpharmacologic lifestyle modifications whereas moderate to severe cases may require adjunct therapies such as NSAIDs, Duloxetine, intra-articular glucocorticoids, and as a last resort, surgery {3}. Although end-stage knee OA can be treated with total knee arthroplasty, conservative treatment for patients who are not surgical candidates or for those who want to delay surgery is a challenge. GAE may serve to narrow this gap. In one single-arm trial of GAE, 68% of subjects continued to have marked symptomatic improvement at 12 months post treatment {4}. Vascular Interventional Radiologists should be made aware of this novel treatment modality for the treatment of refractory OA.

Clinical Findings/Procedure Details: In this exhibit we begin by highlighting the pathophysiology of OA and its debilitating effects on the patient and their quality of life. We continue by detailing the current treatment guidelines used for the management of OA. We will then discuss specifically GAE, a promising approach for the treatment of moderate to severe knee OA.

Conclusion and/or Teaching Points: OA is a complicated, multifactorial disease process that can greatly impair the function of one's life. There are a variety of treatment algorithms that may be used based on severity of disease. Typically a combination of therapeutic approaches must be used for the proper management of OA. Specifically, Vascular Interventional Radiologists can perform GAE for refractory, symptomatic patients.