Imipenem/Cilastatin Versus Imipenem/Cilastatin Plus Ethiodized Oil in Genicular Artery Embolization: Safety and...

To evaluate whether genicular artery embolization (GAE) performed with imipenem/cilastatin (IPM/CS) followed by ethiodized oil (Lipiodol Ultra-Fluide; IPM/CS+L) is associated with higher clinical success without increased adverse events compared with IPM/CS alone in patients with symptomatic knee osteoarthritis (OA).

This retrospective cohort study included 77 patients (IPM/CS: n = 47; IPM/CS+L: n = 30) treated between May 2024 and February 2025. Eligible patients had symptomatic OA (Kellgren-Lawrence Grades 1-4) and persistent pain (visual analog scale [VAS] >50 mm). Primary end points were longitudinal changes in VAS and Western Ontario and McMaster Universities Osteoarthritis Index scores over a 6-month follow-up; secondary end points included adverse events and technical/clinical success. Data were analyzed using generalized estimating equations adjusted for baseline characteristics.

Both groups achieved significant improvements in pain and physical function at 6 months (P < .05), with no significant between-group differences in overall clinical success. A significant agent × time interaction was observed at 1 month (P = .024), indicating a greater early reduction in VAS scores in the IPM/CS+L group; this effect did not sustain at 3 or 6 months. The median number of embolized arteries was lower in the IPM/CS+L group (2 vs 3; P = .040). No severe adverse events occurred, and mild adverse events, including transient skin discoloration, were comparable between groups.

GAE performed with either IPM/CS alone or a combined IPM/CS+L regimen is safe and provides significant symptomatic relief for knee OA. While ethiodized oil offers technical advantages, it does not confer superior long-term clinical effectiveness compared with IPM/CS alone.