Periarticular cooling reduces non-target perfusion in genicular artery embolization: a quantitative angiographic...

Genicular artery embolization (GAE) is an emerging, effective pain treatment for symptomatic knee osteoarthritis. A potential concern of this procedure is non-target embolization of cutaneous and subcutaneous vessels, which can lead to severe skin complications such as necrosis. To mitigate this risk, some operators use periarticular cooling with the rationale of inducing vasoconstriction. The vasoconstrictive effect on non-target subcutaneous vessels caused by cooling has, however, not yet been objectively demonstrated. This study aims to provide the first objective evidence for this common safety maneuver.

This retrospective analysis is based on a cohort of 36 patients (39 knees). The study evaluated a total of 49 selective angiographies of medial or lateral genicular arteries, which were stratified based on the presence of a superficial blush. Three cohorts were defined for comparison: 1) The Cooling Cohort, comprising 20 angiographies (from 10 knees) that showed a blush and were treated with periarticular cooling. 2) The Blush-Control Cohort, consisting of 18 angiographies (from 18 knees) with a blush but without a cooling maneuver. 3) The No-Blush Control Cohort (11 knees). The blush area on DSA was quantitatively analyzed for both groups with a superficial blush; in the Cooling Cohort, the area was compared before and after the intervention, while the baseline blush was quantified for the Blush-Control Cohort. Skin-related adverse events were systematically recorded and compared at the patient level across all three cohorts.

The application of periarticular cooling resulted in a significant reduction in the mean blush area from 464.8 ± 447.6 mm² to 240.1 ± 208.2 mm² (p = 0.012), corresponding to an average reduction of 73.8% (p = 0.0006). Patients receiving cooling showed significantly fewer skin alterations than the blush-control group [median score 1 vs 2, p = 0.0174].

Periarticular cooling is a simple, non-invasive, and effective technique that significantly reduces quantifiable non-target cutaneous perfusion during GAE. Our work provides objective evidence supporting its use as a standard safety-enhancing maneuver to minimize the risk of skin-related complications.