Classification of Genicular Artery Anatomic Variants Using Intraoperative Cone-Beam Computed Tomography

Area of Science:

• Interventional Radiology
• Vascular Anatomy
• Osteoarthritis Treatment

Background:

• Genicular artery embolization (GAE) is an emerging treatment for symptomatic knee osteoarthritis.
• Detailed understanding of genicular arterial anatomy is crucial but limited in published literature.
• Intraprocedural imaging is vital for precise targeting during GAE.

Purpose of the Study:

• To delineate the complex genicular artery anatomy using intraprocedural cone-beam computed tomography (CBCT).
• To analyze the prevalence, course, and branching patterns of genicular arteries during GAE procedures.
• To identify common anatomical variations relevant to GAE.

Main Methods:

• Retrospective analysis of 222 patients undergoing GAE between May 2018 and April 2022.
• Inclusion criteria: technically adequate intraprocedural CBCT scans.
• CBCT analysis focused on identifying and characterizing genicular arteries and their branching patterns.

Main Results:

• 205 patients (92%) with adequate CBCTs were analyzed.
• High prevalence of descending genicular artery (96%), superior medial genicular artery (91%), superior lateral genicular artery (99%), inferior medial genicular artery (95%), inferior lateral genicular artery (95%), and median genicular artery (97%).
• Four distinct branching patterns were identified, with common origin of SLGA and MGA being most frequent (56%). Recurrent ascending tibial (76%) and superior patellar arteries (85%) were also noted.

Conclusions:

• Genicular artery anatomy is intricate, featuring numerous common variations.
• CBCT is an effective tool for rapid identification of target vessels during GAE.
• Accurate anatomical mapping with CBCT can potentially reduce the risk of non-target embolization.