title: Technically Successful Geniculate Artery Embolization Does Not Equate Clinical Success for Treatment of Recurrent Knee Hemarthrosis after Knee Surgery.
abstract: OBJECTIVE
  To evaluate technical details, clinical outcomes, and complications in patients undergoing geniculate artery embolization for treatment of spontaneous hemarthrosis after knee surgery.
  
  
  METHODS
  During 2009-2014, 10 consecutive patients (seven women; mean age, 57.4 y) underwent geniculate artery embolization at a single tertiary care center. All patients except one had hemarthrosis after total knee replacement (TKR). One patient presented with hemarthrosis after cartilage surgery. Two patients in the TKR group had a history of TKR revisions before the embolization. Embolization was performed with polyvinyl alcohol particles (range, 300-700 µm). In one patient requiring repeat embolization, N-butyl cyanoacrylate/ethiodized oil was used. The endpoint for embolization was stasis in the target artery and elimination of the hyperemic blush.
  
  
  RESULTS
  In 10 patients, 14 embolizations were performed with 100% technical success. Hemarthrosis resolved in six patients. Four patients required repeat embolization for recurrent hemarthrosis, which subsequently resolved in two of four patients. Three of the four patients who required repeat embolization had serious comorbidities, either blood dyscrasias or therapeutic anticoagulation. There were two minor skin complications that resolved with conservative management. The average length of follow-up after embolization was 545 days (range, 50-1,655 d). One patient was lost to follow-up.
  
  
  CONCLUSIONS
  Geniculate artery embolization is a safe, minimally invasive treatment option for spontaneous and refractory knee hemarthrosis after knee surgery with 100% technical success. However, limited clinical success and higher repeat embolization rates were noted in patients with serious comorbidities.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri. Electronic address: guevarac@mir.wustl.edu.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Guevara
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Robert
authors.initials: R
authors.lastname: Barrack
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Darcy
mesh_terms: D000293:Adolescent; D000368:Aged; D015901:Angiography, Digital Subtraction; D001158:Arteries / Q000000981:diagnostic imaging; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004659:Enbucrilate / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006395:Hemarthrosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007719:Knee Joint / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000008:administration & dosage; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004998:Ethiodized Oil; D011142:Polyvinyl Alcohol; D004659:Enbucrilate