Genicular Artery Embolization (GAE) for knee osteoarthritis pain
A minimally invasive procedure that helps reduce knee pain for patients with osteoarthritis (OA) by decreasing abnormal blood flow to the joint lining — performed without incisions, general anesthesia, or an overnight stay.
Procedure time
30–60 minutes
Anesthesia
Local + light sedation
Outpatient
Same-Day, Outpatient Procedure
Access site
Tiny needle puncture, groin or ankle
What is GAE?
Genicular artery embolization treats the vascular contribution to knee pain rather than the joint structure itself.
How it works
GAE is a minimally invasive procedure used to treat chronic knee pain, particularly caused by osteoarthritis. It involves inserting a catheter into the arteries that supply blood to the knee joint, specifically targeting the genicular arteries. Tiny particles (microspheres) are then injected through the catheter to reduce blood flow to the inflamed synovium — the joint lining — which helps decrease inflammation and pain.
An arteriogram (an x-ray with contrast dye) is used to map the vessels feeding the knee before the interventional radiologist guides the catheter into multiple knee joint vessels to complete treatment.
Who performs it
- An interventional radiologist, a physician trained in image-guided, catheter-based procedures
- Performed in an angiography suite with fluoroscopic (real-time x-ray) imaging
- Often done in coordination with a referring orthopedist or rheumatologist
Where it fits: GAE is generally considered for patients with knee osteoarthritis pain that has not responded adequately to conservative measures, and who wish to delay or avoid knee replacement surgery.
Benefits of GAE
Compared to other procedures like total knee replacement, arthroscopy, or steroid injections, GAE offers a different risk and recovery profile.
Minimally Invasive Procedure
Reduced Risk of Side Effects and Complications
Quick Recovery with Minimal Downtime
Preserves Tissue
Unlike surgery, GAE avoids general anesthesia and the risks associated with large incisions or implants. It also provides a longer-lasting solution than steroid injections, which may only offer temporary relief. For many patients seeking to delay or avoid surgery, GAE represents an option for managing chronic knee pain with fewer risks and a quicker return to daily activities — though as with any procedure, individual results vary and candidacy should be confirmed with your physician.
Candidacy
Candidacy is determined individually after imaging review and clinical evaluation. The lists below outline general criteria discussed in consultation.
Often appropriate for
- Chronic knee pain (typically 3+ months) from mild-to-moderate osteoarthritis
- Pain not adequately controlled with medication, physical therapy, or injections
- Patients who want to postpone or avoid total knee replacement
- Patients who are poor surgical candidates for other medical reasons
- Localized pain corresponding to a specific region of the knee
Typically excluded
- Active knee joint infection
- Severe peripheral arterial disease limiting catheter access
- Uncorrectable bleeding disorder
- Pregnancy
- End-stage/extremely severe arthritis that is best treated with knee replacement surgery. We evaluate each patient individually to determine whether GAE is a good option.
- Allergy to contrast or embolic agents that cannot be managed
The day of the procedure
The majority of procedures take 30–60 minutes, depending on the vascular network and other factors.
Check-in and preparation
Vital signs, IV placement, and a review of medications and allergies.
Access site numbing
Local anesthetic is applied at the groin or ankle. Light IV sedation is typically offered; general anesthesia is not usually required.
Catheter navigation
A small catheter is guided under fluoroscopic imaging into the genicular arteries supplying the knee. Contrast dye maps the vessels supplying the affected area.
Embolization
Tiny embolic materials are delivered through a catheter into the small blood vessels supplying the inflamed lining of the knee. By reducing the excess blood flow that fuels inflammation, the treatment helps relieve pain while preserving the healthy tissues of the knee.
Closure and recovery room
GAE is an outpatient procedure, so patients go home the same day. You will be monitored closely by the healthcare team for approximately one hour before discharge.
Recovery & discharge instructions
Most patients resume light activity within a day or two, with full normal activity typically by day three. Pain relief tends to build gradually over the following weeks.
| Timeframe | What to expect |
|---|---|
| Weeks 2–6 | Gradual reduction in baseline knee pain for many patients; prior physical activity may be resumed without restrictions. |
| 3–6 months | Improved pain scores and knee function; imaging is not usually warranted. |
Immediately after the procedure
- Rest quietly at home today; do not over-exert yourself over the next week — rest if you become tired
- Mild tenderness, a small area of hardness, and bruising at the puncture site are expected
- Do not drive or operate mechanical or electrical equipment
- Do not consume alcohol, tranquilizers, sedatives, sleeping medication, or any non-prescribed medication
- Drink plenty of liquids — anesthesia can cause dehydration
- Eat light meals and snacks to help manage nausea
- Do not make important decisions (e.g., signing legal documents) the day of your procedure
- No submersible water activities for 2 days; climbing household stairs is fine
Up to 48 hours, and general guidelines
- Remove the puncture site bandage 24 hours after the procedure — do not replace it, and avoid lotion, powder, or creams on the area
- Resume your regular diet as tolerated and keep increasing fluids; blood thinners can typically be restarted the next day, and other medications continued as prescribed
- Do not lift more than 5 lbs. for one week following your procedure
- For fever, over-the-counter Tylenol or Motrin can be used; complete any prescribed antibiotic or steroid course (e.g., Medrol dose pack) as directed
- Appetite loss is common — opt for bland foods and small, frequent meals if nauseous, and take any prescribed anti-nausea medication
- Most patients can resume normal activities three days after the procedure
Risks and considerations
GAE is generally well tolerated, but as with any catheter-based, image-guided procedure, risks exist. Your interventional radiologist will review all of these with you before you provide consent.
Common
Access-site bruising
Bruising, tenderness, or a small area of hardness at the groin or ankle puncture site, usually resolving within days.
Common
Post-embolization effects
Temporary increase in knee discomfort, mild fever, or appetite loss in the first few days as tissue responds.
Rare
Allergic reaction
Reaction to the iodinated contrast dye used for imaging; screened for in advance.
Rare
Non-target embolization
Unintended blockage of blood flow to nearby skin of the leg or foot, which can cause a temporary skin rash.
Rare
Vessel injury
Injury requiring additional treatment, including the remote possibility of vessel rupture.
Rare
Incomplete relief
Pain reduction varies by patient; some do not experience meaningful symptom improvement.
A formal written consent, reviewing these risks and alternatives in full, is completed with your care team prior to treatment.
Meet your interventional radiologists
GAE at Florida Radiology Consultants is offered by board-certified interventional radiologists with fellowship training in vascular and interventional care.
Aaron Heligman, MD
Board Certified Interventional Radiologist
Dr. Heligman was born in Chicago, IL and raised in Fort Myers, Florida. He attended the University of Miami for his undergraduate studies and earned his medical degree at Rush University in Chicago, where he was inducted into the Alpha Omega Alpha Honor Medical Society.
He completed his internship in Chicago, followed by his Diagnostic Radiology residency, a Musculoskeletal Radiology mini-fellowship, and a Vascular and Interventional Radiology fellowship at Jackson Memorial Hospital and University of Miami Health System — where he received extensive training in PAE under Dr. Shivank Bhatia, one of the pioneers of the procedure.
Dr. Heligman specializes in interventional oncology, venous disease, prostate artery embolization (PAE), uterine artery embolization (UAE), and minimally invasive spine interventions. He is board-certified with the American Board of Radiology in diagnostic and interventional radiology.
Dr. Heligman focuses on the complete care of his patients, providing quality, patient-centered pre-procedure consultation and post-procedure management, and works collaboratively with providers across medical and surgical specialties in a multi-disciplinary fashion.
David Johnson, MD
Board Certified Interventional Radiologist
Dr. Johnson is a graduate of Vanderbilt University School of Medicine in Nashville, TN. He completed his residency in Diagnostic Radiology in 2016 and his fellowship in Vascular and Interventional Radiology in 2017, both at Vanderbilt University Medical Center.
He is board-certified in Interventional Radiology and Diagnostic Radiology by the American Board of Radiology, and has been practicing interventional radiology in Southwest Florida since 2017, treating a broad range of vascular and oncologic conditions.
Dr. Johnson is passionate about genicular artery embolization (GAE) and the growing field of musculoskeletal embolization, including treatments for plantar fasciitis, frozen shoulder/adhesive capsulitis, and other types of joint and extremity pain. He is committed to bringing innovative, minimally invasive treatment options and improved quality of life to patients living with chronic pain and limited mobility.
About Florida Radiology Consultants
For half a century, Florida Radiology Consultants has been a key provider of diagnostic and interventional radiology services in Southwest Florida. In collaboration with Lee Health, one of the region’s foremost healthcare systems, the practice offers a full spectrum of imaging services — X-rays, CT, MRI, ultrasound, nuclear medicine, and specialized breast imaging.
Florida Radiology Consultants
24301 Walden Center, Suite 102
Bonita Springs, FL 34134
T: 239.331.5566 | F: 239.494.4501
E: IR-FRC@floridaradiology.net
floridaradiologyconsultants.com
Frequently asked questions
Does GAE replace the need for knee replacement?
No. GAE addresses pain associated with joint inflammation and abnormal blood vessel growth; it does not rebuild cartilage or correct joint deformity. It is generally used to reduce pain and delay surgery, not as a substitute for replacement in severe structural disease.
How soon will I notice pain relief?
Many patients begin to notice gradual improvement within 2–6 weeks after the procedure. Pain relief often continues to build over the following months, with some patients experiencing continued improvement for 6–12 months as inflammation decreases and the knee heals. The degree and timing of improvement vary from person to person.
How long will the improvement from this procedure last?
For patients who respond well to GAE, pain relief can last for several years, although this can vary patient to patient. While the procedure does not cure arthritis, many patients experience meaningful, lasting symptom relief. If knee pain gradually returns over time, repeat embolization treatment or other therapies may be considered.
Can both knees be treated in one visit?
This depends on the individual case and is discussed with the interventional radiologist beforehand — some practices treat one knee at a time to monitor response.
Will insurance cover GAE?
Coverage varies by insurer but this is typically covered by traditional Medicare. Certain commercial and Medicare Advantage plans can have variable coverage for GAE, however. Confirm coverage and any prior authorization requirements with your insurance provider. Our office accepts most major insurers.
What imaging or workup is needed beforehand?
Depending on your history, imaging scans such as x-ray or MRI may be used to evaluate the knee. We will review your medical records and medical history and assess if any additional imaging or laboratory testing is necessary.
Ready to discuss your candidacy?
Schedule a consultation with an interventional radiologist at Florida Radiology Consultants to review your imaging and history.
Florida Radiology Consultants
Bonita Springs, FL 34134
T: 239.331.5566 · F: 239.494.4501
E: IR-FRC@floridaradiology.net
Scheduling
Scheduling: (239) 331.5566 · Fax: (239) 494.4501
www.floridaradiologyconsultants.com
This reference sheet is provided for general educational purposes only and does not constitute medical advice. It is not a substitute for a consultation with a qualified interventional radiologist or other physician, who can evaluate individual imaging, history, and candidacy. Always discuss the risks, benefits, and alternatives of any procedure with your care team before making a treatment decision.
Please note that your physician may have a financial interest in some of the technology utilized during surgery at the treatment location in which you are considering. Please take time to research the recommended procedure and physicians who offer this treatment in your area to ensure you are fully informed of your options when seeking the location of your surgery.