Joint & Vascular Institute is proud to recognize Dr. Osman Ahmed, MD, FSIR, FCIRSE, for his contribution as a co-author of a newly published international expert consensus article on genicular artery embolization, commonly known as GAE.
Published in CardioVascular and Interventional Radiology, the article, “Genicular Artery Embolization for Chronic Knee Pain: Expert Consensus Recommendations on Indications, Technique and Clinical Care Using a Delphi Process“, brings together the experience of 29 interventional radiologists from around the world.
The experts evaluated 75 statements during three rounds of review. Consensus was reached on 71 statements, creating a practical framework for selecting patients, performing GAE, and providing follow-up care.
For patients considering GAE for chronic knee pain, this work represents an important step toward greater consistency in how the procedure is evaluated and delivered.
What Is Genicular Artery Embolization?
Genicular artery embolization is a minimally invasive procedure designed to address chronic knee pain associated with inflammation and abnormal blood vessel growth around the knee.
During GAE, an interventional radiologist guides a small catheter into selected arteries supplying the knee. Tiny embolic particles are then delivered to targeted abnormal vessels. The goal is to reduce the excessive blood flow and inflammatory activity that may contribute to osteoarthritis-related pain.
GAE is generally performed as an outpatient procedure through a very small access point. It does not involve removing or replacing the knee joint, and patients can typically return home the same day.
Not every person with knee pain is an appropriate candidate. A careful evaluation is necessary to determine the cause of the pain, review prior treatments, assess medical history, and decide whether GAE should be considered.
Why Was an Expert Consensus Needed?
As the use of GAE has expanded, physicians and researchers have used varying approaches to patient selection, procedural technique, embolic materials, and follow-up.
The newly published article was designed to identify areas where experienced GAE specialists agree and to highlight questions that still require further research.
The authors used a Delphi process, a structured method for developing expert consensus through multiple rounds of anonymous scoring and review. Consensus required at least 75 percent of the participating experts to rate a statement seven or higher on a 10-point scale.
All 29 experts completed the full three-round process. Agreement was reached on 71 of the 75 statements.
The four statements that did not reach consensus are also meaningful. They identify areas where evidence or clinical experience remains insufficient for a uniform recommendation. This distinction helps prevent expert opinion from being presented as certainty and provides direction for future research.
Key Findings From the GAE Consensus Article
Patient selection should be structured and individualized
The panel agreed that GAE may be considered for patients with chronic knee pain that has not responded adequately to conservative treatment for at least three months.
The consensus recommendations included patients with mild through severe radiographic knee osteoarthritis, classified as Kellgren-Lawrence grades 2 through 4. Other potential indications included certain knee tendinopathies, recurrent bleeding into the knee joint, persistent pain after an uncomplicated total knee replacement, or the need for a bridge before knee replacement.
A minimum pain score of 5 on a 10-point numeric rating scale was supported as part of GAE candidacy. However, these recommendations do not replace an individual medical evaluation.
Clinical examination and knee imaging remain important
The experts recommended that the assessment before GAE include:
- A clinical examination
- Standardized pain and function measurements
- Knee radiographs
Contrast-enhanced MRI may also be helpful in selected patients. The panel considered MRI optional for evaluating inflammation, identifying other possible causes of pain, and assessing features that could help predict treatment response.
This supports a thoughtful approach in which the source of knee pain is evaluated before a procedure is recommended.
GAE technique should be tailored to the patient
The panel reached consensus that visible genicular arteries should be evaluated and that arteries demonstrating abnormal increased blood flow should be considered for embolization.
The article also reported that current evidence has not established the superiority of temporary or permanent embolic agents for either safety or effectiveness. The choice of technique and embolic material should therefore be guided by the patient’s anatomy, clinical needs, and the treating physician’s judgment.
Follow-up is part of GAE care
The consensus recommendations emphasize that the interventional radiologist’s role should continue after the procedure.
Structured, long-term follow-up was recommended, with treatment success evaluated through meaningful changes in pain, function, and patient satisfaction. Repeat GAE may be considered when the initial response is insufficient or pain returns. Treatment of the opposite knee may also be considered for patients with bilateral symptoms.
This focus on follow-up aligns with the patient-centered philosophy at Joint & Vascular Institute. Treatment is not viewed as an isolated procedure, but as one part of a personalized care plan.
What Does This Mean for Patients With Severe Knee Osteoarthritis?
One notable part of the consensus is the inclusion of patients with severe radiographic osteoarthritis among those who may be considered for GAE.
This does not mean that every person with severe osteoarthritis should undergo embolization. It means that severe findings on an X-ray should not automatically end the conversation.
A separate open-access CVIR study of 43 patients with Kellgren-Lawrence grades 2 through 4 reported improvements in pain and function following GAE, including among patients with severe osteoarthritis. The study used permanent microspheres and reported no complications other than temporary skin discoloration in four patients. However, it was a single-center study without a control group, so its findings should be interpreted within those limitations.
The emerging message is that candidacy should be based on the full clinical picture, including symptoms, imaging, prior treatments, health history, and individual goals.
Dr. Ahmed’s Role in Advancing GAE Research
Dr. Osman Ahmed is a globally recognized interventional radiologist and a leader in musculoskeletal embolization. He is a Fellow of both the Society of Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe.
Dr. Ahmed has authored numerous peer-reviewed publications and has helped advance minimally invasive embolization techniques for chronic joint pain. His participation in this international consensus panel reflects his continued commitment to improving GAE research, clinical standards, and patient care.
For patients at Joint & Vascular Institute, this academic involvement means access to a physician who contributes to the scientific discussion surrounding the procedures he performs.
Exploring GAE for Chronic Knee Pain
If knee osteoarthritis pain continues despite physical therapy, medication, injections, or other conservative treatments, GAE may be worth discussing with an experienced interventional radiologist.
A consultation at Joint & Vascular Institute includes an individualized assessment of your symptoms, imaging, prior treatments, and overall health. If GAE is not appropriate, the team can discuss other minimally invasive options that may better address the source of your pain.
Joint & Vascular Institute serves patients from Libertyville, Rockford, Chicago, and communities throughout Northern Illinois.
Schedule a consultation to learn whether genicular artery embolization may be an option for your chronic knee pain.
Individual outcomes vary. GAE is not appropriate for every patient, and consultation with a qualified healthcare professional is necessary to determine candidacy.