Geniculate Artery Embolization in Knee Hemarthrosis and Osteoarthritis

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Musculoskeletal: 1.50

Radiography: 0.50
Procedures: 0.50
Extremity Procedures: 0.50

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Musculoskeletal and Endocrine Sections: 1.50
Neurological, Vascular, and Lymphatic Sections: 0.50

Sonography: 0.50
Procedures: 0.50
Superficial Structures and Other Sonographic Procedures: 0.50

Vascular-Interventional Radiography: 1.50
Procedures: 1.50
Vascular Interventional Procedures: 1.50

Outline

1. Introduction
2. Hemarthrosis
   1. Pathophysiology
   2. Clinical Manifestations and Diagnosis
   3. Treatment
3. Osteoarthritis
   1. Pathophysiology
   2. Clinical Manifestations and Diagnosis
   3. Treatment
4. Geniculate Artery Embolization
   1. Anatomy
   2. Procedure and Technical Details
   3. Embolic Agents for GAE
   4. GAE in Hemarthrosis
   5. GAE in Osteoarthritis
   6. Complications
5. Conclusion

Objectives

Upon completion of this course, students will:

1. recognize the prevalence of Americans over 60 with chronic pain due to knee OA
2. identify the outcomes or results for those suffering with knee OA
3. identify the durability of response for patients undergoing GAE of the knee
4. recognize the clinical manifestations of knee hemarthrosis
5. identify the initial preferred imaging modality when hemarthrosis is suspected
6. identify the imaging modality which shows chronic sequelae of intra-articular hemorrhage, including cartilage and meniscal destruction.
7. recognize the reference standard technique to confirm hemarthrosis
8. understand the outcomes of using conservative treatment for hemarthrosis
9. recognize the factors fueling inflammatory drive and degenerative osteoarthritic changes in patients with knee OA
10. be familiar with the KL classification system for OA
11. be familiar with conservative treatments for patients with knee OA
12. be familiar with the burden of disease in patients with knee OA
13. identify the genicular arteries that are targets when performing GAE
14. recognize the genicular arteries providing vascularization of the patella and patellar tendon
15. be familiar with palpating the general target area prior to catheterization
16. identify the size of the microcatheter for GAE for knee OA
17. recognize the vasculature of the knee
18. be familiar with techniques used to better characterize the anatomy during GAE
19. identify the general embolic classification for GAE
20. identify the non-filling of the lateral genicular branches and loss of synovial blush on imaging
21. be familiar with the drug IPM-CS
22. be familiar with the KL grade findings for the patients studied
23. be familiar with the use of Embospheres in patients studied
24. be familiar with the percentage of patients experiencing hematomas during GAE studies
25. identify the particle sizes for IPM-CS used in GAE for knee OA
26. be familiar with the clinical success of those patients studied after TKA
27. be familiar with the technical success of those studied receiving GAE for knee OA
28. be familiar with the total clinical success reported after recurrent GAE for the patients studied
29. identify the total complication rate for patients undergoing GAE for knee OA
30. recognize the clinical assessment tools to evaluate GAE for treatment of OA
31. be familiar with KOOS classification ratings
32. identify the patient group based on KL ratings for which GAE may not be optimal
33. recognize the potential positive outcomes for performing GAE for knee OA
34. identify the most common complication after performing GAE for knee OA
35. be familiar with the effect embolic particle size has on preventing transient cutaneous complication in GAE