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.
Read More Case Studies
Modern Vascular offers a library of case studies authored by doctors at our clinics detailing cases before and after intervention.