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Knee Arthritis

Genicular Artery Embolization

Osteoarthritis is a condition that is caused by repetitive wear and tear of the joint. Damage To the cartilage results in persistent inflammation that causes tiny new blood vessels and nerves to grow within the knee joint. Genicular Artery Embolization is a procedure that injects microscopic beads into the areas with abnormal blood vessels, so they are reduced, drastically minimizing the pain associated with abnormal vessels.

Knee  Pain: GAE
Knee GAE
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What is GAE or Genicular Artery Embolization for Knee Pain?
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Procedural Details

The interventional Radiologist makes a small needle puncture into a blood vessel at the top of the leg and guides a microcatheter into the blood vessels that supply the inflamed part of the knee. The procedure is performed under a ‘twilight sleep’ and is relatively painless. 

Microscopic beads are injected into the areas with abnormal vessels and hypervascularity, reducing the excessive flow causing the pain and swelling. Normal blood flow to the knee and its surrounding tissues remains intact after the procedure.

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Advantages of GAE
  • No surgical incision or injection into the knee joint

  • Painless procedure lasting about one hour

  • Typically return to work within a day or two without the need for a lengthy recovery

  • Very low complication rate without any effect on future knee replacement 

  • Symptom improvement usually within 1-3 weeks

Why GAE?

GAE is useful to relieve knee pain from OA instead of taking frequent medication or getting injections into the knee. It can also be beneficial in those who are not ready to have a knee replacement surgery. Published clinical studies by our team have demonstrated that GAE can provide pain relief without the risks associated with chronic medication or having to get repeat injections.

 

GAE, However, is not necessarily a substitute for total knee replacement and has not been shown to negatively impact future knee replacement surgery when performed with our technique.

Publications

Multicenter Randomized Sham Controlled Study of Genicular Artery Embolization for Knee Pain Secondary to Osteoarthritis

Sandeep Bagla, MD, Rachel Piechowiak, DO, Abin Sajan, MD, Julie Orlando, BHS,
Terry Hartman, MPH, MS, CCRC, and Ari Isaacson, MD

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2022 Journal of Vascular and Interventional Radiology Editor's Award for Outstanding Clinical Research

Genicular Artery Embolization for the
Treatment of Knee Pain Secondary to Osteoarthritis

Sandeep Bagla, MD, Rachel Piechowiak, DO,
Terry Hartman, MPH, MS, CCRC, Julie Orlando, BHS,
Daniel Del Gaizo, MD, and Ari Isaacson, MD

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Frequently Asked Questions
  • What Happens During The Aquablation Procedure?
    Aquablation therapy is performed in a hospital. You will be under anesthesia for the entire procedure. The procedure typically takes less than an hour and involves an overnight stay. There are two key steps to the procedure—creating a surgical map and removing the prostate tissue.
  • What Happens Immediately After The Aquablation Therapy?
    As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7. 3. Data on file at PROCEPT BioRobotics.
  • What Is Recovery Like After Aquablation Therapy?
    As with most BPH procedures, you will wake up with a catheter following Aquablation therapy, which allows you to urinate while your urethra heals. Patients typically stay overnight in the hospital. While no one likes staying overnight in a hospital, the benefit with Aquablation therapy is that most patients end up leaving the hospital without a catheter.1,2,3 Once you’re home, you may experience mild burning during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor. References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7. 3. Data on file at PROCEPT BioRobotics.
  • What Is The Cost Of Aquablation Therapy?
    The cost of Aquablation therapy will depend on what country you live in and what type of insurance you have.
  • Does My Insurance Cover Aquablation Therapy?
    For patients in the United States, two of the major national private insurance companies (Anthem and Humana) have issued positive coverage policies for its patients. For all other private insurance companies, coverage can be assessed on an individual basis, and you should speak with your provider directly to determine if Aquablation therapy is available for you. For patients outside of the United States, reimbursement and coverage vary by geography. We recommend patients contact their local physician providers to determine if Aquablation therapy is available.
  • What Is Aquablation Therapy?
    Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera (called a cystoscope) with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is, and has a very low rate of irreversible complications—incontinence, ejaculatory dysfunction, erectile dysfunction.1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
  • Who Is An Appropriate Candidate For Aquablation Therapy?
    Aquablation therapy has been proven as a safe and effective treatment for patients suffering from lower urinary tract symptoms (LUTS) due to BPH. Aquablation therapy can be performed on prostates of any size.
  • Who Performs Aquablation Therapy Surgery?
    Your urologist performs Aquablation therapy using the AquaBeam Robotic System. The procedure takes place in a hospital. When our team performs embolization prior to Aquablation therapy, the PAE will be performed by a Vascular Interventional Radiologist
  • How Common Is Aquablation Therapy Surgery?
    Aquablation therapy is commercially available in the United States, Canada, Europe, United Kingdom, the Middle East and Asia.
  • Is Aquablation Therapy FDA Approved?
    Yes, Aquablation therapy is performed by the AquaBeam Robotic System, which was cleared by the FDA in December 2017.
  • Does Aquablation Therapy Have CE Mark?
    Yes. Aquablation therapy is performed by the AquaBeam Robotic System, which received CE Mark in 2014.
  • What Are The Risks Associated With Aquablation Therapy?
    The most common side effects are mild and temporary. These may include mild pain, bleeding or strain while peeing, discomfort in the pelvis, inability to empty the bladder, a frequent and/or urgent need to urinate, and bladder or urinary tract infection. Other risks include ejaculatory dysfunction and a low risk of injury to the urethra or rectum. For more information about potential side effects and risks associated with Aquablation therapy, speak with your urologist or surgeon. With the most significant risk in clinical studies being bleeding, the team has worked to improve this outcome by performing PAE or embolization prior to Aquablation. This has been performed with clinical results showing an improvement in bleeding rate, discharge to home, and complications compared to published studies.
  • What Are The Clinical Results?
    Aquablation therapy has been studied in seven different clinical trials. It has been shown to be a safe and effective treatment for patients suffering from lower urinary tract symptoms (LUTS) due to BPH. Aquablation therapy can be performed on prostates of any size. References: 1. NCT03191734 – French Aquablation Clinical Investigation Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue 2. NCT03123250 – Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue II (WATERII) 3. NCT02974751 – Global Post-Market Registry Using Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (OPEN WATER) 4. NCT02505919 -Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue (WATER) 5. NCT03167294 – AquaBeam India Study for the Treatment of Benign Prostatic Hyperplasia (ABS) 6. NCT03125863 – Acute Hemostasis Following the Use of the AquaBeam® System for the Treatment of Benign Prostatic Hyperplasia (AHA) 7. NCT03125889 – Acute Hemostasis Following the Use of the AquaBeam® System for the Treatment of Benign Prostatic Hyperplasia II (AHA II)
  • What Is The AquaBeam Robotic System?
    The AquaBeam Robotic System performs Aquablation therapy.
  • Why Is The AquaBeam Robotic Surgery Better?
    Aquablation therapy is a one-of-a-kind procedure. It is the only procedure that uses a heat-free waterjet controlled by robotic technology to remove prostate tissue and combines a camera (called a cystoscope) with ultrasound imaging, giving the surgeon the ability to see the entire prostate in real time. As a result, Aquablation therapy is precise, consistent and predictable and provides long-term relief no matter how large your prostate is. It has a very low rate of irreversible complications—incontinence, ejaculatory dysfunction, erectile dysfunction.1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
  • Does The Treatment Impact Sexual Function?
    Aquablation therapy has a very low rate of irreversible complications (incontinence, ejaculatory dysfunction, erectile dysfunction).1,2 References: 1. Gilling, P, et al. Three-Year Outcomes after Aquablation Therapy Compared to TURP: Results from a Blinded Randomized Trial. Can J Urol. 2020 Feb;27(1):10072-10079. 2. Bhojani, N, et al. Aquablation for Benign Prostatic Hyperplasia in Large Prostates (80-150 cc): 1-Year Results. Urology. 2019 Jul;129:1-7.
  • What Are The Side Effects?
    Once you’re home, you may experience mild burning sensation and urgency during urination for a couple of weeks. This can be managed with mild pain medication. Patients can resume their normal activities once approved by their doctor.
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