After One Knee Replacement, She Chose GAE Again

Cynthia Schraf-Fletcher, 74, says genicular artery embolization nearly matched the relief she previously got from a total knee replacement—while letting her return to gardening and exercising with far less pain. The minimally invasive outpatient procedure redu

Cynthia Schraf-Fletcher didn’t wait for the pain to fade.

Nearly a year after her outpatient genicular artery embolization on her right knee, she tells it the way you can only tell it when you’re living with the outcome. The result, she says, is nearly identical to the total knee replacement she had previously done on her left knee.

“I couldn’t be more pleased,” says Schraf-Fletcher, 74, who turned to Leigh Casadaban, MD, MS—assistant professor of radiology at the University of Colorado Anschutz School of Medicine—for the procedure.

Now, she says, gardening, exercising on a stationary bicycle, and all her favorite activities come with far less pain and, just as importantly, far more enjoyment.

For people trapped in the middle of a long knee-pain path, Schraf-Fletcher’s story lands in a space many patients recognize: medications, physical therapy, maybe a steroid injection—and then, if nothing works, the jump to total knee replacement.

Casadaban, a vascular interventional radiologist, describes genicular artery embolization as a minimally invasive option that may fill that gap. “For treating osteoarthritis in the knees. we often think of medications. physical therapy. maybe a steroid injection. and then on the far end of the spectrum is a total knee replacement. There really hasn’t been anything for patients in between,” he says. “GAE is a promising minimally invasive procedure that may fill that spot for people who have failed conservative treatments but are not yet ready to have a major surgery.”.

At the center of the procedure is a simple idea: decrease blood flow to inflamed areas of a joint to reduce swelling and pain. “Genicular artery embolization decreases blood flow to the inflamed areas of a joint, which can reduce swelling and pain,” Casadaban explains.

What that looks like in practice is where the procedure’s “in-between” appeal becomes physical. Schraf-Fletcher says she had complications with her knee replacement surgery, and that pushed her to try GAE.

The procedure itself can take one to two hours under conscious sedation. An interventional radiology team makes a small incision in the crease of the leg and threads a tiny catheter through the femoral artery with guidance from X-ray imaging and contrast. When the team reaches the genicular arteries. they release tiny beads that block blood flow to the abnormal vessels in the specific areas the patient identifies.

Afterward, clinicians observe patients for a few hours, and then patients go home the same day with instructions to take it easy for a few days.

For Casadaban, success is not universal—it’s tied to the kind of osteoarthritis a patient has. “The best candidates for the procedure are people who have mild to moderate osteoarthritis,” he says. While those with more severe cases can have the procedure done. he adds. results don’t tend to be as long-lasting.

He points to clinical outcomes: “We find about 70% of patients have phenomenal results. They cut their pain scores in half, sometimes more. We have a few patients with no pain at all after the procedure.”

Casadaban describes why that matters—because for people who’ve tried many other treatments without relief, the procedure can feel like a route back to normal life. “Patients that have tried a lot of other treatments and haven’t had pain relief are happy to get back to their normal activities.”

There’s also a growing policy and research trail behind the procedure. GAE originated in Japan just over a decade ago and has grown considerably across the globe. In the U.S., the FDA has granted “breakthrough device status” for many devices since 2021.

The data so far remains limited but encouraging. “The theory is that GAE reduces inflammation inside the knee joint, and symptom relief can last years,” Casadaban says. “Four-year data published in Japan shows that if you have one outpatient procedure. your pain relief can last for those four years. In the U.S. we now have two-year data. which shows that if you have a good response. pain relief can last two years. That really speaks to the theory that we’re hopefully modifying something in the joint.”.

That theory is driving ongoing work at CU Anschutz. Casadaban is leading clinical trials at CU Anschutz—one specifically looking at changes in fluid in the knee in patients undergoing GAE. and the other studying a new temporary treatment device in the arteries called Nexsphere-F that blocks small blood vessels in the knee that may be related to inflammation and pain.

While GAE is only being used in knees right now, Casadaban says the approach is expanding to other joint treatments, including frozen shoulder, tennis elbow, and plantar fasciitis.

For Schraf-Fletcher, the day-to-day difference is already clear. After complications with her knee replacement surgery. she chose an alternative—and nearly a year later. she says the relief she gets is close to what she experienced before. without having to live inside the pain that started pushing her off the activities she loves.

genicular artery embolization GAE chronic knee pain osteoarthritis knee replacement FDA breakthrough device status CU Anschutz Leigh Casadaban Nexsphere-F