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

• Published in: Cardiovascular and interventional radiology Vol. 46; no. 5; pp. 628 - 634
• Main Authors: Callese, Tyler E., Cusumano, Lucas, Redwood, Karen D., Genshaft, Scott, Plotnik, Adam, Stewart, Jessica, Padia, Siddharth A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-05-2023; Springer Nature B.V
• Subjects: Anatomy; Arteries; Cardiology; Clinical Investigation; Computed tomography; Cone classifiers; Cone-Beam Computed Tomography; Embolization; Humans; Imaging; Knee - blood supply; Lower Extremity; Medicine; Medicine & Public Health; Nuclear Medicine; Osteoarthritis; Popliteal Artery; Radiology; Retrospective Studies; Review boards; Risk reduction; Tomography; Ultrasound; Veins & arteries; Arterial interventions; Embolization; Osteoarthritis; Genicular artery embolization
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-023-03411-3

Purpose
Genicular artery embolization (GAE) is a new treatment option for symptomatic knee osteoarthritis. Genicular arterial anatomy is complex with limited published reports. This study describes the genicular artery anatomy utilizing intraprocedural cone-beam computed tomography (CBCT) during GAE.
Materials and Methods
This retrospective single-center study was approved by the institutional review board. All patients who underwent GAE between May 2018 and April 2022 were reviewed. Patients with a technically adequate CBCT were included in the analysis. CBCTs were analyzed to determine the presence, course, and branching patterns of the genicular arteries.
Results
A total of 222 patients underwent GAE and 205 (92%) were included for analysis. The descending genicular artery was present in 197 (96%) CBCTs with two branches in 152 (77%). The superior medial genicular artery (SMGA) was present in 186 (91%), superior lateral genicular artery (SLGA) in 203 (99%), inferior medial genicular artery (IMGA) in 195 (95%), inferior lateral genicular artery (ILGA) in 196 (95%), and median genicular artery (MGA) in 200 (97%). Four unique branching patterns were identified: common origin of SLGA and MGA (115, 56%), unique origins (45, 22%), trifurcation of SLGA, SMGA, and MGA (32, 15.5%), and common origin of SMGA and MGA (12, 6%). The recurrent ascending tibial was identified in 156 (76%) CBCTs and superior patellar artery in 175 (85%) CBCTs.
Conclusion
Genicular artery anatomy is complex with numerous common variants. CBCT is a powerful adjunct in GAE to rapidly identify target vessels for embolization and potentially decrease the risk of nontarget embolization.