This week’s Modern Vascular featured case comes from Dr. Zagum Bhatti, Vascular Interventional Radiologist for Modern Vascular in Houston, TX.

Featured Case Overview

A 58-year-old female presented to our clinic with complaints of chronic, worsening right knee pain. The pain mainly occurs along the lateral aspect of the knee and worsens with standing. She underwent bilateral knee arthroscopic surgery 10 years ago, without relief of right knee pain. She has received right knee intraarticular steroid and hyaluronic injections every six months for the past 2 years, which provided only transient relief. She has also tried physical therapy with limited results. Ultimately, she was offered total knee replacement which she declined. Detailed knee examination performed in our clinic revealed focal tenderness along the lateral knee joint. There was no evidence of other internal derangements. Right knee radiographs demonstrated medial and lateral compartment narrowing and mild osteophyte formation. Her WOMAC pain score was 78.

Ipsilateral antegrade common femoral artery access was obtained and a 5 French sheath was placed. A 5 French Berenstein catheter was advanced into the mid superficial femoral artery and angiography was performed. Given the patient’s symptoms were primarily along the lateral aspect of her knee, the superior lateral genicular artery was first selectively catheterized with a 2.4 Fr microcatheter and angiography performed. This showed no abnormal synovial perfusion. Next, the inferior lateral genicular artery was selectively catheterized with the microcatheter.

Angiography performed within this artery showed prominent hypervascularity of the synovium. The hyperemic synovium was then embolized with 0.5 cc of 100-300 um microspheres diluted in 10 cc of contrast. Post embolization angiogram showed satisfactory results with resolution of hypervascularity but the preservation of the inferior lateral genicular artery. Finally, super selection of the anterior tibial recurrent genicular artery was performed with angiography showing no synovial hyperemia.

The patient was seen in the clinic 1 week after her embolization. She reported a complete resolution of knee pain. Our clinic will follow up with her in 3 months and, subsequently, at 6-month intervals.

Medial and lateral joint compartment osteoarthritis

Medial and lateral joint compartment OA.

Angiogram of right leg above the knee

Nonselective right leg angiogram at the level of the knee.

Inferior later genicular artery with synovial hyperemia

Selective angiogram from the inferior lateral genicular artery showing synovial hyperemia.

Reduction of hypervascularity

Post embolization selective angiogram showing marked reduction of hypervascularity with preserved patency of the genicular artery.

Meet the Doctor

Dr. Zagum Bhatti

Dr. Zagum Bhatti
Vascular Interventional Radiologist

Dr. Bhatti is a board-certified Vascular and Interventional Radiologist. He completed his medical training at Medical College of Wisconsin and residency at Michigan State University. He then completed fellowships in Neuroradiology and Vascular and Interventional Radiology (VIR) at MCW and Rush University Medical Center, respectively.

Learn more about Dr. Zagum Bhatti

Dr. Zagum Bhatti Modern Vascular Clinic

Modern Vascular of Houston

7103 South Peek Rd. #300
Richmond, TX 77407

Office Hours: 7am - 5pm CST

Phone: (346) 758-8414

Fax: (346) 396-1055

Email: [email protected]