Genicular Artery Embolization: Recent Advances in Managing Knee Osteoarthritis Pain

doi:10.3877/cma.j.issn.2095-5782.2026.02.003

Abstract

Abstract:

Knee Osteoarthritis (KOA), characterized by significant and persistent pain and functional impairment, has emerged as a major global cause of disability. The core mechanism underlying its pain involves mechanical injury and joint degeneration triggering a vicious cycle of "synovitis-vascular proliferation-aberrant innervation-sensitization". Conventional conservative treatments (such as NSAIDs and intra-articular injections) offer limited efficacy, while Total Knee Arthroplasty (TKA) is constrained by its high-risk profile and prolonged recovery period. Genicular Artery Embolization (GAE), an emerging minimally invasive interventional therapy, aims to alleviate pain by selectively embolizing abnormal neovessels within the knee joint. This targeted approach disrupts the neurovascular coupling pathway mediated by synovial inflammation. This article systematically reviews the current evidence-based basis regarding the pathophysiology of KOA pain, GAE's clinical efficacy, safety profile, and key ongoing deliberations. It evaluates the potential value and positioning of GAE within the stepwise treatment framework for KOA and explores future research directions.

Key words: genicular artery embolization, knee osteoarthritis, pain management

Fujun Wang, Xuan Wang, Jingxian Zhang. Genicular Artery Embolization: Recent Advances in Managing Knee Osteoarthritis Pain[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(02): 141-149.

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References 45

[1]	Chlorogiannis DD, Vasilopoulou A, Konstantinidis CI, et al. Kneepain improvement after genicular artery embolization for the management of knee osteoarthritis: an updated systematic review and meta-analysis of 21 studies[J]. Radiologie(Heidelb), 2024, 64(Suppl 1): 32-46.
[2]	Giaretta S, Magni A, Migliore A, et al. A Review of Current Approaches to pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape[J]. J Clin Med, 2024, 13(17): 5176.
[3]	Sellam J, Berenbaum F. The role of synovitis inpathophysiology and clinical symptoms of osteoarthritis[J]. Nat Rev Rheumatol, 2010, 6(11): 625-635.
[4]	Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis[J]. Nat Rev Rheumatol, 2012, 8(7): 390-398.
[5]	Okuno Y, Korchi AM, Shinjo T, et al. Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment[J]. J Vasc Interv Radiol, 2017, 28(7): 995-1002.
[6]	Padia SA, Genshaft S, Blumstein G, et al. Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis[J]. JB JS Open Access, 2021, 6(4): e21. 00085.
[7]	中国骨关节炎诊疗指南专家组, 中国老年保健协会疼痛病学分会, 黄东, 等. 中国骨关节炎诊疗指南(2024版)[J]. 中华疼痛学杂志, 2024, 20(03): 323-338.
[8]	Bagla S, Piechowiak R, Sajan A, et al. Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee pain Secondary to Osteoarthritis[J]. J Vasc Interv Radiol, 2022, 33(1): 2-10. e2.
[9]	Taslakian B, Swilling D, Attur M, et al. Genicular Artery Embolization for Treatment of Knee Osteoarthritis: Interim Analysis of a prospective pilot Trial Including Effect on Serum Osteoarthritis-Associated Biomarkers[J]. J Vasc Interv Radiol, 2023, 34(12): 2180-2189. e3.
[10]	Little MW, Gibson M, Briggs J, et al. Genicular artEry embolizatioN in patiEnts with oSteoarthrItiS of the Knee (GENESIS) Using Permanent Microspheres: Interim Analysis[J]. Cardiovasc Intervent Radiol, 2021, 44(6): 931-940.
[11]	Ro DH, Jang MJ, Koh J, et al. Mechanism of action of genicular artery embolization in a rabbit model of knee osteoarthritis[J]. Eur Radiol, 2023, 33(1): 125-134.
[12]	Angelini F, Widera P, Mobasheri A, et al. Osteoarthritis endotype discovery via clustering of biochemical marker data[J]. Ann Rheum Dis, 2022, 81(5): 666-675.
[13]	Schmelz M, Mantyh P, Malfait AM, et al. Nerve growth factor antibody for the treatment of osteoarthritis pain and chronic low-back pain: mechanism of action in the context of efficacy and safety[J]. Pain, 2019, 160(10): 2210-2220.
[14]	Labarre KW, Zimmermann G. Long-term effects of infrapatellar fat pad SVF infiltration in knee osteoarthritis management: A prospective cohort study[J]. Bone Rep, 2025, 24: 101827.
[15]	Manocchio N, Pirri C, Ljoka C, et al. Long-Term Efficacy of Carboxymethyl-Chitosan in Advanced Knee Osteoarthritis: A Twelve-Month Follow-Up Study on Non-Responders to Hyaluronic Acid[J]. Biomedicines, 2025, 13(2): 270.
[16]	Talaie R, Torkian P, Clayton A, et al. Emerging Targets for the Treatment of Osteoarthritis: New Investigational Methods to Identify Neo-Vessels as Possible Targets for Embolization[J]. Diagnostics (Basel), 2022, 12(6): 1403.
[17]	张昊, 靳勇. 经导管动脉栓塞术治疗膝骨关节炎临床应用及进展[J]. 介入放射学杂志, 2025, 34(02): 206-212.
[18]	Brown JM, Vandeveer ZT, Cadoret D, et al. Genicular Artery Embolization: A Technical Review of Anatomy, Pathophysiology, Current Experiences, and Future Directions[J]. J Clin Med, 2025, 14(6): 2106.
[19]	Bhatia S, Jalaeian H, Kumar J, et al. Two-year outcomes comparing Embosphere® microspheres versus Imipenem Cilastatin for genicular artery embolization inpatients with moderate to severe knee osteoarthritis[J]. Knee, 2023, 41: 38-47.
[20]	Okuno Y, Korchi AM, Shinjo T, et al. Transcatheter arterial embolization as a treatment for medial kneepain inpatients with mild to moderate osteoarthritis[J]. Cardiovasc Intervent Radiol, 2015, 38(2): 336-343.
[21]	Guevara-Noriega KA, Chavez-Abiega R, Castro-Rios JG. Embolization of genicular arteries inpatients with knee osteoarthritis as an alternative for refractorypain treatment: A systematic review[J]. Med Clin(Barc), 2022, 159(12): 592-597.
[22]	Ashraf N, Tahir MJ, Arabi TZ, et al. Safety and Efficacy of Genicular Artery Embolization for Knee Joint Osteoarthritis Associated pain: A Systematic Review[J]. J Endovasc Ther, 2025: 15266028251326770.
[23]	Epelboym Y, Mandell JC, Collins JE, et al. Genicular Artery Embolization as a Treatment for Osteoarthritis Related Kneepain: A Systematic Review and Meta-analysis[J]. Cardiovasc Intervent Radiol, 2023, 46(6): 760-769.
[24]	李永奇, 王刚刚, 王禹基, 等. 膝动脉栓塞治疗膝骨关节炎继发性疼痛的疗效与安全性荟萃分析[J]. 中华医学杂志, 2024, 104(45): 4162-4170.
[25]	Gill SD, Hely R, Hely A, et al. Outcomes after Genicular Artery Embolization Vary According to the Radiographic Severity of Osteoarthritis: Results from a prospective Single-Center Study[J]. J Vasc Interv Radiol, 2023, 34(10): 1734-1739.
[26]	Sun C, Chen Y, Gao Z, et al. Genicular artery embolization for the treatment of knee pain secondary to mild to severe knee osteoarthritis: One year clinical outcomes[J]. Eur J Radiol, 2024, 175: 111443.
[27]	Lee SH, Hwang JH, Kim DH, et al. Clinical Outcomes of Transcatheter Arterial Embolisation for Chronic Knee Pain: Mild-to-Moderate Versus Severe Knee Osteoarthritis[J]. Cardiovasc Intervent Radiol, 2019, 42(11): 1530-1536.
[28]	Hindsø L, Hölmichp, Petersen MM, et al. Transarterial Embolization of Geniculate Arteries Reduces pain and Improves physical Function in Knee Osteoarthritis-A prospective Cohort Study[J]. Diagnostics(Basel), 2024, 14(15): 1627.
[29]	孙长浩, 高知玲, 林坤, 等. 选择性膝动脉栓塞术治疗膝骨关节炎继发性疼痛的疗效分析[J]. 中华医学杂志, 2022, 102(11): 795-800.
[30]	Koucheki R, Dowling KI, Patel NR, et al. Characteristics of Imipenem/Cilastatin: Considerations for Musculoskeletal Embolotherapy[J]. J Vasc Interv Radiol, 2021, 32(7): 1040-1043. e1.
[31]	Torkianp, Golzarian J, Chalian M, et al. Osteoarthritis-Related Knee pain Treated With Genicular Artery Embolization: A Systematic Review and Meta-analysis[J]. OrthopJ Sports Med, 2021, 9(7): 23259671211021356.
[32]	Correa MP, Motta-Leal-Filho JM, Lugokeski R, et al. GAUCHO-Trial Genicular Artery Embolization Using Imipenem/Cilastatin vs. Microsphere for Knee Osteoarthritis: A Randomized Controlled Trial[J]. Cardiovasc Intervent Radiol, 2022, 45(7): 903-910.
[33]	Sapoval M, Querub C, Pereira H, et al. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial[J]. Diagn Interv Imaging, 2024, 105(4): 144-150.
[34]	Min J, Park SW, Hwang JH, et al. Evaluating the Safety and Effectiveness of Quick-Soluble Gelatin Sponge Particles for Genicular Artery Embolization for Chronic Knee pain Associated with Osteoarthritis[J]. J Vasc Interv Radiol, 2023, 34(11): 1868-1874.
[35]	Landers S, Hely R, Hely A, et al. Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial[J]. Bone Jt Open, 2023, 4(3): 158-167.
[36]	Taheri Amin A, Frommhold I, Huebner A, et al. Genicular Artery Embolization in Moderate to Severe Knee Osteoarthritis: Technique, Safety and Clinical Outcome[J]. Cardiovasc Intervent Radiol, 2025, 48(3): 340-350.
[37]	Dablan A, Erdim Ç, Güzelbey T, et al. Effectiveness of Genicular Artery Embolization for Reducing Synovitis as Assessed by Contrast-Enhanced MR Imaging in Knee Osteoarthritis: A pilot Study[J]. J Vasc Interv Radiol, 2024, 35(9): 1313-1322. e6.
[38]	Hindsø L, Hölmichp, Petersen MM, et al. Reduction in Synovitis Following Genicular Artery Embolization in Knee Osteoarthritis: A prospective Ultrasound and MRI Study[J]. Diagnostics(Basel), 2024, 14(22): 2564.
[39]	Wang B, Tai TW, Liang KW, et al. Short-Term Effects of Genicular Artery Embolization on Symptoms and Bone Marrow Abnormalities inpatients with Refractory Knee Osteoarthritis[J]. J Vasc Interv Radiol, 2023, 34(7): 1126-1134. e2.
[40]	Little MW, O'Grady A, Briggs J, et al. Genicular Artery embolisation inpatients with Osteoarthritis of the Knee (GENESIS) Using permanent Microspheres: Long-Term Results[J]. Cardiovasc Intervent Radiol, 2024, 47(12): 1750-1762.
[41]	Van Zadelhoff TA, Bos PK, Moelker A, et al. Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial[J]. BMJ Open, 2024, 14(10): e087047.
[42]	Bagla S, Piechowiak R, Hartman T, et al. Genicular Artery Embolization for the Treatment of Knee pain Secondary to Osteoarthritis[J]. J Vasc Interv Radiol, 2020, 31(7): 1096-1102.
[43]	Poursalehian M, Bhia I, Ayati Firoozabadi M, et al. Genicular Artery Embolization for Knee Osteoarthritis: A Comprehensive Review[J]. JBJS Rev, 2023, 11(9) : e23.
[44]	Hernández-Yumar A, González-Hernández Y, Delpino-Sedeño T, et al. Genicular artery embolization for knee osteoarthritis : a systematic review with meta-analysis and cost-analysis[J]. Gac Sanit, 2025, 39: 102459.
[45]	Lee L, Epelboym Y. Review of genicular artery embolization, radiofrequency ablation, and cryoneurolysis in the management of osteoarthritis-related knee pain[J]. Diagn Interv Radiol, 2023, 29(4): 614-620.

研究代码	研究类型	样本量	K–L分级	主要终点	再干预率	并发症率	不良反应发生率（随访时间）	参考文献
Landers S 2023	前瞻性单中心三盲RCT	58例（干预29例，对照30例）	2级 100%	KOOS疼痛评分变化	1.7%（对照1例6个月行TKA）	无严重并发症；轻微5例（穿刺瘀斑）	12个月：轻微8.5%，严重0%	[35]
van Zadelhoff TA 2024	前瞻性单中心双盲RCT	58膝（单侧）	1级6.9%，2级36.2%，3级56.9%	KOOS疼痛评分	0%	无严重并发症；GAE组轻微28例次，假手术组5例次	4个月：GAE组79.3%，假手术组17.2%	[41]
Gill SD 2023	前瞻性单中心队列	35膝（单侧）	2级33.3%，3级48.5%，4级18.2%	达标响应率	0%	无严重并发症；轻微2例次（瘀青、皮肤发红）	6个月：总6.1%	[25]
Sun C 2024	前瞻性单中心队列	37膝	轻中度1~2级28膝，重度3~4级9膝	VAS、WOMAC、临床成功率	3.0%（1例）	无严重并发症；轻微9例	12个月：轻微27.3%，严重0%	[26]
Lee SH 2019	前瞻性单中心队列	71膝	轻中度1~3级59膝，重度4级12膝	多时点VAS变化	7.3%（重度3例6个月行TKA）	无严重并发症；轻微10例	12个月：轻微14.1%，严重0%	[27]
Hindsø L 2024	前瞻性单中心单臂队列	17例（技术成功率85%）	1级12%，2级41%，3级47%	VAS、患者报告结局	0%	无严重并发症；轻微6例	6个月：轻微35.3%，严重0%	[28]
孙长浩 2022	前瞻性单中心单臂队列	23膝	2级21.7%，3级47.8%，4级30.1%	VAS、WOMAC	0%	无严重并发症；轻微7例	6个月：轻微41.2%，严重0%	[29]
Sapoval M 2024	前瞻性多中心开放队列	23膝	3级45%，4级55%	术后1个月严重不良事件	0%	严重1例（造影剂肾损伤）；轻微2例	1个月：严重4.5%，轻微9.1%	[33]
Taheri Amin A 2025	前瞻性单中心单臂队列	43膝（单侧）	1级21%，2级37%，3级42%	KOOS疼痛评分变化	11.6%（5例4~11个月行TKA）	轻微4例（短暂皮肤发红）	12个月：总9.3%	[36]
Hindsø L 2024	前瞻性单中心单臂队列	17膝	2级12%，3级41%，4级47%	滑膜炎评分	0%	无并发症	6个月：轻微0%，严重0%	[38]
Wang B 2023	前瞻性单中心队列	24膝	1级20.8%，2级58.3%，3级20.8%	骨髓病变、VAS	13.6%（3例行TKA）	无严重并发症；轻微7例次	6个月：轻微31.8%，严重0%	[39]
Little MW 2024	前瞻性单中心单臂队列	40例（技术成功率87%）	1级10.9%，2级41.3%，3级47.8%	VAS、KOOS	22.5%（9例18个月行TKA）	严重1例（腘窝DVT）；轻微6例次	2年：轻微15%，严重2.5%	[40]
Bagla S 2020	前瞻性多中心单臂队列	20膝（单侧）	1级10%，2级50%，3级40%	VAS、WOMAC	0%	无严重并发症；轻微16例次	6个月：轻微80%，严重0%	[42]
Min J 2023	回顾性单中心队列	97膝	未报告	VAS、技术/临床成功率	未报告	无严重并发症；轻微59例次	6个月：轻微60.8%，严重0%	[34]
Dablan A 2024	回顾性单中心单臂队列	35膝	2级57%，3级29%，4级14%	滑膜炎半定量评分	0%	无严重并发症；轻微6例次	3个月：轻微17.1%，严重0%	[37]

研究代码	研究类型	样本量	K–L分级	主要终点	再干预率	并发症率	不良反应发生率（随访时间）	参考文献
Landers S 2023	前瞻性单中心三盲RCT	58例（干预29例，对照30例）	2级 100%	KOOS疼痛评分变化	1.7%（对照1例6个月行TKA）	无严重并发症；轻微5例（穿刺瘀斑）	12个月：轻微8.5%，严重0%	[35]
van Zadelhoff TA 2024	前瞻性单中心双盲RCT	58膝（单侧）	1级6.9%，2级36.2%，3级56.9%	KOOS疼痛评分	0%	无严重并发症；GAE组轻微28例次，假手术组5例次	4个月：GAE组79.3%，假手术组17.2%	[41]
Gill SD 2023	前瞻性单中心队列	35膝（单侧）	2级33.3%，3级48.5%，4级18.2%	达标响应率	0%	无严重并发症；轻微2例次（瘀青、皮肤发红）	6个月：总6.1%	[25]
Sun C 2024	前瞻性单中心队列	37膝	轻中度1~2级28膝，重度3~4级9膝	VAS、WOMAC、临床成功率	3.0%（1例）	无严重并发症；轻微9例	12个月：轻微27.3%，严重0%	[26]
Lee SH 2019	前瞻性单中心队列	71膝	轻中度1~3级59膝，重度4级12膝	多时点VAS变化	7.3%（重度3例6个月行TKA）	无严重并发症；轻微10例	12个月：轻微14.1%，严重0%	[27]
Hindsø L 2024	前瞻性单中心单臂队列	17例（技术成功率85%）	1级12%，2级41%，3级47%	VAS、患者报告结局	0%	无严重并发症；轻微6例	6个月：轻微35.3%，严重0%	[28]
孙长浩 2022	前瞻性单中心单臂队列	23膝	2级21.7%，3级47.8%，4级30.1%	VAS、WOMAC	0%	无严重并发症；轻微7例	6个月：轻微41.2%，严重0%	[29]
Sapoval M 2024	前瞻性多中心开放队列	23膝	3级45%，4级55%	术后1个月严重不良事件	0%	严重1例（造影剂肾损伤）；轻微2例	1个月：严重4.5%，轻微9.1%	[33]
Taheri Amin A 2025	前瞻性单中心单臂队列	43膝（单侧）	1级21%，2级37%，3级42%	KOOS疼痛评分变化	11.6%（5例4~11个月行TKA）	轻微4例（短暂皮肤发红）	12个月：总9.3%	[36]
Hindsø L 2024	前瞻性单中心单臂队列	17膝	2级12%，3级41%，4级47%	滑膜炎评分	0%	无并发症	6个月：轻微0%，严重0%	[38]
Wang B 2023	前瞻性单中心队列	24膝	1级20.8%，2级58.3%，3级20.8%	骨髓病变、VAS	13.6%（3例行TKA）	无严重并发症；轻微7例次	6个月：轻微31.8%，严重0%	[39]
Little MW 2024	前瞻性单中心单臂队列	40例（技术成功率87%）	1级10.9%，2级41.3%，3级47.8%	VAS、KOOS	22.5%（9例18个月行TKA）	严重1例（腘窝DVT）；轻微6例次	2年：轻微15%，严重2.5%	[40]
Bagla S 2020	前瞻性多中心单臂队列	20膝（单侧）	1级10%，2级50%，3级40%	VAS、WOMAC	0%	无严重并发症；轻微16例次	6个月：轻微80%，严重0%	[42]
Min J 2023	回顾性单中心队列	97膝	未报告	VAS、技术/临床成功率	未报告	无严重并发症；轻微59例次	6个月：轻微60.8%，严重0%	[34]
Dablan A 2024	回顾性单中心单臂队列	35膝	2级57%，3级29%，4级14%	滑膜炎半定量评分	0%	无严重并发症；轻微6例次	3个月：轻微17.1%，严重0%	[37]

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