Feasibility of Pedal Access for Geniculate Artery Embolization

Monday, March 31, 2025

4:45 PM – 4:50 PM CT

Location: Music City Center, 207 AB

Abstract Presenter(s)

EH

Eusha R. Hasan

Medical Student
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States

Author/Co-author(s)

Ali Saifuddin, MD

Resident
Rutgers, Robert Wood Johnson Medical School, United States
PS

Philip Schuchardt, MD

Resident Physician
Moffitt Cancer Center, United States
JK

Joe Khoury, DO, MBA

Resident Physician
Northwell Health, United States
VG

Vaiva Gustainyte, DO

Attending Physician
Moffitt Cancer Center, United States
CY

Christopher Yeisley, MD

Attending Physician
David Grant USAF Medical Center, United States
MA

Mustafa Al-Roubaie, MD

Associate Professor
Moffitt Cancer Center, United States

Learning Objectives: 1.) Explain how pedal access serves as an alternative option to groin access in geniculate artery embolization (GAE) for symptomatic refractory knee osteoarthritis (OA).
2.) Recognize the clinical situations in which pedal access may be preferable due to anatomical challenges or comorbidities.
3.) Understand the potential benefits and technical considerations of pedal access versus groin access for GAE.

Background: GAE is a minimally invasive treatment modality for refractory symptomatic knee OA in patients who are not candidates for total knee arthroplasty {1}. The most common access point for GAE is via the groin through the contralateral or ipsilateral common femoral artery (CFA) {2, 3}. However, in patients with unfavorable groin anatomy, overlying infections, morbid obesity, or CFA atherosclerosis, groin access can be technically challenging or infeasible {2}. Groin access in morbidly obese patients may increase the risk of infection or hematoma, due to the increased depth of penetration, and cause subsequent difficulty achieving hemostasis. In these scenarios, pedal access offers a viable second-line approach.

Clinical Findings/Procedure Details: Pedal access for GAE begins with 21G needle access into either the dorsalis pedis or posterior tibial artery, depending on operator preference. If the dorsalis pedis is accessed, an 0.018 wire is advanced into the anterior tibial artery. A 4/5F hydrophilic slender sheath is placed over the wire, with its tip positioned in the distal anterior tibial artery. Contrast is injected to confirm patency of the dorsalis pedis artery. Through the sheath, a 4F angled catheter is used to navigate to the SFA, where angiography is performed to identify the geniculate arteries. The angled catheter and a microcatheter/wire system is then used to catheterize the geniculate arteries. At this point, the geniculate arteries that supply hyperemic areas of synovium are embolized with 100-300μm particles. The goal is to reduce synovial inflammation by reducing hyperemia, ultimately causing pain relief.

Conclusion and/or Teaching Points: Pedal access is a feasible alternative for GAE in patients with significant comorbidities or challenging anatomy that complicate groin access. Pedal access may necessitate a higher technical threshold for navigating smaller caliber vasculature and more frequent anatomic variations. Nonetheless, pedal access allows for similar clinical outcomes as groin access with regards to pain relief and improved knee function for patients with symptomatic knee OA.