Future considerations Since the publication of our initial trial, there has been a tremendous amount of anticipation for this therapy to be ready for routine clinical use. However, there is still work to be done. A larger pivotal study, involving a more substantial number of patients and centers, will be needed for the FDA to grant labeling for GAE to a specific embolic particle. Once this occurs, the process of obtaining reimbursement from Centers for Medicare and Medicaid Services (CMS) and private insurers can begin. Additionally, evidence from a larger trial could strengthen the argument that GAE should become standard of care for OA knee pain and added to various societal guidelines for treatment of this condition.


Within the burgeoning field of musculoskeletal embolization for pain, GAE for osteoarthritic pain is the tip of the iceberg. There may be pain from other knee conditions that could be improved by breaking the inflammatory cycle through embolization. Early investigation of embolization for pain in anatomical sites other than the knee has already taken place, including the shoulder, the elbow and the Achilles tendon. Early evidence also suggests that pain after total knee arthroplasty can be treated with embolization.


In another prospective investigational device exemption (IDE) study that we have recently concluded, embolization significantly improved pain and function in patients with adhesive capsulitis of the shoulder. While this condition is less prevalent than knee OA, there is no consistently effective therapy to treat it. Although the majority of cases self- resolve, it can take months or years for


1967


The Judkins technique of coronary is introduced; it remains the most widely used technique today.


Selective vasoconstriction infusions for hemorrhage are introduced, and are now commonly used for bleeding ulcers, gastric bleeding and arterial bleeding.


the improvement in pain and stiffness to occur, leading to life-altering disability. With embolization, there is the potential of dramatically decreasing the duration of these symptoms and reducing the time patients have to be out of work.


Another intriguing feature of these procedures is that they can all be done on an outpatient basis, with minimal recovery time. While GAE has only been reported from femoral access and requires at least a 2-hour recovery, shoulder embolization can be done from a transradial approach with even shorter recovery times before discharge. These features make embolization for musculoskeletal pain ideal for an outpatient-based lab setting, in which they can be performed efficiently while providing a convenient experience for the patient. The environment also lends itself to easy integration with outpatient orthopedic and rheumatology clinics.


Conclusion All these therapies potentially reduce the need for pain medication. While the opioid crisis in our country is well known, many patients are also affected by complications of chronic nonopioid medication including renal dysfunction, gastrointestinal ulcers and liver disease. As interventional radiologists, we are excited about the potential to treat a new frontier of inflammatory musculoskeletal conditions, helping patients to avoid complications of medication and preventing disability. While the effort will still take a number of years, we envision that, within a decade, musculoskeletal embolization for pain will become a mainstay of care for numerous inflammatory conditions.


in 10 YEARS


WHAT COMES NEXT?


I want to see IRs be accessible to everyone. If you live in a rural area


or an inner city, it is surprisingly difficult to find a high-end IR to help you. I’d like to see that change. I’d like to see more active participation from IRs in bringing more diversity into the practice of IR and medicine itself. There are significant number of people who avoid going into medicine, because the perception is that medicine is not for some people of color and it doesn’t protect them. I want to see that change, and it starts with truly reaching out to our communities.


—DEREK L. WEST, MD, MS


Listen to Dr. Bagla discuss genicular artery embolization on the Kinked Wire podcast with host Warren Krackov, MD, FSIR, at bit.ly/KWire-020.


1968


The first closure of the patent ductus arteriosis, a heart defect in newborns of a vascular opening between the pulmonary artery and the aorta.


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