Pedal access for genicular artery embolization: technique description and procedural workflow

Genicular artery embolization has emerged as a minimally invasive treatment for moderate-to-severe knee osteoarthritis and is traditionally performed via femoral access. With increasing operator familiarity with distal arterial techniques, pedal access represents a feasible alternative. We describe a single-operator technique for performing genicular artery embolization via pedal arterial access developed over more than a decade of experience. Pre-procedural assessment includes duplex ultrasound to evaluate vessel patency and diameter. Under ultrasound guidance, the dorsalis pedis or distal posterior tibial artery is accessed, followed by sheath placement and systemic anticoagulation. Retrograde angiography and roadmap guidance facilitate selective catheterization of genicular branches using a mini-RIM catheter and a no-wire "Jabada" technique. Embolization is performed to reduce hypervascularity while preserving flow. This approach allows efficient workflow, reduced radiation and contrast use, and early ambulation, providing a practical alternative to femoral access for genicular interventions.