Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis

O’Grady, Aiden; Welsh, Luke; Gibson, Matthew; Briggs, James; Speirs, Archie; Little, Mark

Abstract

Purpose
Genicular artery embolisation (GAE) is a novel treatment for patients with knee osteoarthritis (OA). Cadaveric dissection was undertaken to provide a complete description of the relevant arterial anatomy in order to perform safe and effective GAE.

Materials
Twenty human lower limb specimens were dissected. The morphology of the genicular arteries and presence of anastomotic connections was recorded and compared with angiographic images from patients having undergone GAE. Vessels were measured to investigate the risk of non-target embolisation (NTE), taking a diameter of 300 microns as the threshold for significance.

Results
The descending genicular artery (DGA) is the dominant vessel in medial OA, with 95% of cases revealing vessel division into muscular, saphenous and osteoarticular branches from a single pedicle. The superior medial genicular artery (SMGA) had a shared origin with the middle genicular artery (MGA) in 25% of cases. NTE to the MGA may damage the cruciate ligaments. In 85% of cases, there was an anastomosis between the DGA and SMGA, often encountered at angiography. The mean diameter of the anastomoses was 850 micron, presenting a risk for NTE. An anastomosis between the Inferior Medial Genicular Artery (IMGA) and medial sural artery was found in 5% of cases; the medial sural artery supplies blood to the tibial nerve and should be avoided. The IMGA and inferior lateral genicular artery provided supply to the patellofemoral joint in 69% and 88% of cases, respectively.

Conclusion
An in-depth knowledge of genicular artery anatomy is required for interventional radiologists to perform safe and effective GAE in patients with knee osteoarthritis.

• Journal Article Type: Article
• Acceptance Date: Sep 15, 2021
• Online Publication Date: Oct 17, 2021
• Publication Date: 2022-01
• Deposit Date: Jun 21, 2023
• Journal: CardioVascular and Interventional Radiology
• Print ISSN: 0174-1551
• Electronic ISSN: 1432-086X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 45
• Issue: 1
• Pages: 80-90
• DOI: https://doi.org/10.1007/s00270-021-02978-z
• Keywords: Cardiology and Cardiovascular Medicine; Radiology, Nuclear Medicine and imaging
• Additional Information: Received: 23 July 2021; Accepted: 15 September 2021; First Online: 17 October 2021; : ; : MW Little is a paid consultant for Guerbet, Crannmed, Merit Medical, and Boston Scientific. None of the other authors declare a potential conflict of interest.; : All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All training for this anatomical research project was carried out through Keele University’s School of Medicine Anatomical Facilities, under guidance of the HTA licence #12190 (Sect. 16; 2; c of the Human Tissue Act 2004). Prior to the project being conducted it was reviewed by the Anatomical Research Group (ARG) for its suitability to train an Anatomical Science student in scientific method, and subsequently scrutinised for any ethical concerns by the ARG Ethics (sub) Committee (including the HTA Licence Holder, the Facilities Manager, the project coordinator, and 2 representatives of ARG). The project was then detailed for review and documentation by the Keele University Human Tissue Committee.; : Informed consent was obtained from all individual participants included in the GENESIS study.; : Consent for publication was obtained for every individual person’s data included in the GENESIS study.