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BackTable / MSK / Podcast / Transcript #58
Podcast Transcript: Genicular Artery Embolization: How I Do It
with Dr. Osman Ahmed
Genicular artery embolization (GAE) is quickly emerging as a treatment option for knee osteoarthritis when other therapies have failed. In this episode of the BackTable Podcast, Dr. Osman Ahmed discusses the origins of GAE and how he employs it in his practice. You can read the full transcript below and listen to this episode here on BackTable.com.
Table of Contents
(1) Introduction to Genicular Artery Embolization (GAE)
(2) Therapeutic Gaps in Osteoarthritis
(3) Clinical Evidence for GAE
(4) Operative Technique for Outpatient GAE
(5) Embolic Tools in GAE
(6) Procedure Complexity & Complication Management
(7) Future Applications & Research in GAE
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[Dr. Aaron Fritts]
Hello, everyone. Welcome to The BackTable Podcast. Today, we've got another very special episode. We’re going to be discussing genicular artery embolization (GAE) procedure with Dr. Osman Ahmed. This is number three, third time on the show. For those that missed the first two, Oz was on about a year ago, I think, on the Innovation Show where we talked about Flow Medical, right?
[Dr. Osman Ahmed]
That's correct.
[Dr. Aaron Fritts]
Then the second one, not too long ago, where we talked about upper GI bleeds, which is also a fantastic embolization episode, GAE. We've covered it a number of times in the past with Jafar being on, Bagla being on, and Ari being on, but we have actually never really covered the nitty-gritty details of the procedure itself and sort of how somebody goes through it. I actually got to see another plug for Gest MSK. We've plugged it a number of times recently. I actually got to see Oz present on this at Gest MSK in Paris this last January. Again, great conference. Mark Little was on the show recently to talk about MSK embolization as well. He talked more about the data behind it. Great to have you, Oz. Thanks so much for coming on the show again.
[Dr. Osman Ahmed]
No, thank you, Aaron. It's quite the privilege, quite the honor to be on here and a third time's a charm. Let's do it.
[Dr. Aaron Fritts]
That's right. The other great thing for the audience who's maybe listening to this audio, we're actually going to have some video version of it as well. Oz is going to be showing some video cases. We'll put those out on YouTube as well as on BackTable+. We're going to go over anatomy as well. Oz, for those who don't know you, hard to imagine, but just a quick recap of where you're at and what your practice looks like.
[Dr. Osman Ahmed]
You're too kind, sir. Yes, I'm an interventional radiologist. I practice at the University of Chicago. I've now been there, geez, about six years, which time is flying. I'm in my 10th year of practice, which also, again, is crazy when I think back about it. I have been doing a lot of different things. I'm very interested in all aspects of IR, including oncology, deep venous thrombosis, pulmonary embolism.
Most recently now, I have gotten really excited and really interested by MSK embolization specifically and started an MSK embo practice, I would say, actually about almost three or four years ago now when this really, really first came overseas, from overseas to the US, and now have built up a pretty good practice, I think, where we're seeing about five or six patients a week in clinic and about half of those are turning into actual procedures.
(1) Introduction to Genicular Artery Embolization (GAE)
[Dr. Aaron Fritts]
Fantastic. Yes. Just to quickly segue into it, how did you first become interested in specifically the topic of today, GAE, genicular artery embolizations?
[Dr. Osman Ahmed]
Yes, it's a good question. I think I've always just been interested in innovation and the new aspects of IR and what's out there. I think what's really drawn me to GAE, aside from obviously the fact that it can treat arthritis in a very unique and innovative way, is that it truly addresses a treatment gap. I think a lot of what we do, for better or worse, is a competing strategy or a competing therapy.
With GAE specifically, what I think drew me to this specific procedure was that with arthritis, there's not a lot of great interventions. There's medical therapies, there's surgery, and then there's really nothing in between. There's a ton of patients out there, and we can get into the epidemiology if you want, but there's a ton of patients out there who actually just don't have any options. I think what was really exciting about this is that this really evolved to address that treatment gap and really address those patients who have nothing else. I think that's what's allowed the practice to also really grow really fast.
(2) Therapeutic Gaps in Osteoarthritis
[Dr. Aaron Fritts]
We touched on a little bit last time with Mark Little about what the ideal patient looks like for this, because like you said, sometimes it's even just younger patients who have really bad OA. You don't want to put an implant in them because they're going to have to have a repeat implant at some point. Orthopedics are really happy about this procedure, it sounds like. For the uninitiated, will you just tell us about the knee OA disease process, like you were saying, the incidence and prevalence, and how these patients are typically presenting in your practice?
[Dr. Osman Ahmed]
Yes, for sure. When we talk about knee OA, it's a highly prevalent disease. About 15 million patients in the US alone suffer from it. Huge public health problem. It's the number one cause of chronic disability, physical activity limitation in patients. The way that I think about it also is that it's the number one thing that a "healthy" person experiences, I think, as they grow older. I think because of that, there's a lot of other negative diseases that are tied to it. Specifically, there's an increased incidence of coronary disease linked to knee OA, and there's also an increased incidence of depression, suicidal ideation, mental health consequences, essentially.
Again, I think this is all related to the fact that you basically were otherwise a healthy person and now have this disease that prevents you from doing all the things that you used to do. Because it's such a major, major highly prevalent disease, I think there's a large population of patients that really would stand to benefit from improved therapies, because the primary way that knee OA is dealt with is with medical management. Medical management includes physical therapy, NSAIDs, whether it's oral or intraarticular, as well as intraarticular gel injections, corticoids, hyaluronic acid. Then you have a ton of other therapies that are out there that really actually aren't that well established in guidelines or accepted.
Again, I think for the patient who has knee OA that is suffering, they're willing to try anything. That includes a ton of other stuff like acupuncture, like PRP injections, things like that. When those things don't work or fail, then you have to start thinking about knee replacement. Again, if you're going from getting like a knee injection to a complete arthroplasty, that's a big jump, and that can be very scary. My mom had a knee replacement, so I saw upfront exactly what that means in terms of the recovery, the pain, all that sort of stuff. It's a great procedure, but there's a lot that's to it.
[Dr. Aaron Fritts]
Yes. My in-laws both have gone through it and it is no joke. You're right. The recovery is not-- they actually recovered faster from spinal surgery, from fusion surgery than they did from their knee. Just you forget how much you rely on that knee joint for just mobility, right? How it can be very painful. Just to back up a little bit about how these patients are coming to your practice, are you seeing them in clinic? Is ortho sending them over? Tell us about how you're building this GAE practice.
[Dr. Osman Ahmed]
Yes, definitely. I think as I mentioned earlier, I started a long time ago, I think probably relatively early adoption phase. When I first learned about it and was very interested by it, the first people I went to was orthopedics. They, I think rightfully so, looked at this and they said, we don't really buy this. You're going to mess up our arthroplasties. You might cause a ischemia to the joint. They weren't really terribly excited. That obviously put up a little bit of a roadblock when I first wanted to get this practice going.
Then I turned towards other specialties that manage OA, because that's another interesting thing about knee OA, is there's not just one specialty that gatekeeps this disease. There's actually, because of how prevalent it is, there's many providers out there that are taking care of these patients just because there's so many. I had a very close relationship with my pain management colleagues, primarily because I was doing a lot of oncology work with them in terms of MSK oncology.
Just in our natural conversations, GAE came up as a alternative therapy for OA and they were performing nerve ablations and they really felt like that procedure didn't work well for their patient population. When I told them about GAE, they got really excited. We set up a study. We got an IDE from the government. We started performing it on some patients. Again, the results spoke for themselves and the practice naturally grew just from that.
By the time we finished that study, the university had advertised that study. I was getting a ton of self-referrals. I was getting every day maybe a couple of patients emailing me interested in the study. By then, I started offering it as standard of care. By then, now that I had my own patient base, I found that orthopedics was a little bit more willing because I had some data. I showed to them that I was doing this in the right way in terms of doing this academically. One person specifically within the orthopedic department who's a KMNR doctor, who's their non-orthopedic orthopedic person, was the person I really specifically collaborated with and he's now my primary referrer. I have also spoken with Rheumatology, I did Grand Rounds. I think, again, what's really rewarding about this procedure is now my referrals come from multiple specialties. Orthopedics, rheumatology, pain management, self-referrals, and also some family medicine. Even just in the community, just people are googling and other docs are seeing that I do this and reaching out. It's great because I don't have just one sort of source that I have to rely on kind of thing.
(3) Clinical Evidence for GAE
[Dr. Aaron Fritts]
Yes, so I guess that was the other question I had, was, for docs who want to add this to their practice and they're talking to potential referrers like ortho or non-ortho docs that treat OA, even primary care docs, are there any pivotal studies that you can direct the audience to to just say-- A lot of times they want to hear about the data. They want to know, okay, how do you know this works? Maybe they're not aware. Is there anything that you use as evidence, either part of the discussion or you send it to them later?
[Dr. Osman Ahmed]
Yes, definitely. I think the data is very important. Again, just thinking about this academically, just pain in general is a hard topic or subject to show beneficial data, if that makes sense. There's obviously a lot of studies led by some of the prior guests that you've had on this, including Mark Little and Jafar, who are trying to help push this field forward with the critical studies that they're doing. When I talk to a new doc or a referring doc, I tell them a couple of things. One, I tell them, believe it or not, this procedure has been around for a long time. It actually was first described by Okuno 10 years ago, 2014 I believe. This is not some wild new concept. It's been done overseas for a while now.
Then when I start talking about studies, I obviously refer to some of his data because, again, he has some of the largest experience. He has MRI correlative data that shows reduction in synovitis. We have some imaging correlates or some imaging biomarkers to show that what we're doing actually reduces the synovitis, shows that on MRI. Then I point to some of those pivotal studies related to some of the guests like we've just talked about, like Mark's GENESIS 1 study, which again recently just published the final cohort with two-year data, which is obviously really, really impressive stuff.
Aside from that, the other data that we like to point out is that the data that exists is not just from one country. I like to point out that we have global data from multiple countries, including the US, Australia, Korea, Japan, England, Netherlands, and all those studies from all the different countries show very similar results in terms of the improvement. It's been validated in that sense as well. There's still ways to go with the data specifically, but I think the existing data is pretty compelling to give a lot of these patients at least a shot to sort of say, hey, you don't have many other options, the data on this is encouraging, it's something that's worth doing.
[Dr. Aaron Fritts]
Yes, exactly. Fantastic. The GENESIS one that you said is probably a great place to start, right, since it just came out? It's the most sort of most recent data out there. How did you learn how to do this procedure?
[Dr. Osman Ahmed]
In short, I taught myself, but I didn't do it, I didn't just jump into it, if that makes sense. I did do a ton of reading. I looked at, obviously, Okuno's. I think Sunny Bagla was one of the early adopters in America, and I remember watching some of his lectures. I think I had actually also had emailed him, he sent me a PowerPoint, it was great in terms of helping me just understand the procedural basics.
I do remember the first case that I did, thinking, okay, I've memorized everything, I know everything, but you do that first angiogram, and it's like, it just hits you. You're like, whoa, there's a lot of little arteries here. Now having done a bunch, it gets really easy really fast. Again, I think that's just a testament to being radiologists, obviously, and that's in our wheelhouse in terms of recognizing anatomy and variants and things like that. I wouldn't say it was trial and error, but definitely, it took a few procedures to get comfortable. The first few procedures, I would say, were a few hours long, but then, now we're doing them routinely in 30 or 40 minutes.
(4) Operative Technique for Outpatient GAE
[Dr. Aaron Fritts]
Yes. Let's talk through day procedure, how you do this. Are you doing femoral access? To start with the access, you're just standard, straightforward case. Then we'll talk a little bit about challenges after that
[Dr. Osman Ahmed]
Yes, for sure. I think I'm lucky that, in our hospital, we actually opened up-- it's like an OBL. It's still in our hospital, but we call it the dialysis access center. We do procedures on a C-arm. I actually think this procedure is very well suited for outpatient work, if that makes sense. Meaning, these are patients who are essentially getting steroid injections.
I want to try to make this procedure, at least in my own practice, as close to that as possible. Meaning, I don't want them to think this is some big, huge procedure. Again, I think one of the ways to do that is I do that in our outpatient center. Those patients come in. Oftentimes I try to convince them to do it just with lidocaine only, and more and more patients are starting to trust me on that.
The way that we do this is they come in, I consent them, they come into the room, we prep the groin, but oftentimes if the patient's obese or has a hostile groin, I'll puncture the SFA. Where I puncture the SFA really is wherever I see it best, so I don't have to necessarily dig into the groin area, it can be proximal thigh. I access the SFA with a micropuncture set. I'd advance a wire down just to make sure that we are within the SFA and because it can be confusing, especially if you're sticking lower you may you may stick a small branch to the profender or something like that. Then I just place a 4 French Glide catheter over an Amplatz wire, so no sheath, nothing.
I really, again, in the spirit of trying to make this as low profile as possible, as outpatient-friendly as possible, I put just a 4 French catheter, do an angiogram, and then at that point it's off to the races. We're just going to go ahead and select whichever genicular artery that seems to be abnormal or seems to supply the region of the patient's pain as well. Again, as we talked about, if you do this enough, this actually gets quite easy over time. Just, the arteries have a relatively predictable origin, relatively predictable course, and once you do this enough, you can learn the shapes that you need to make for your microwire to select those arteries.
Once I select each vessel I do an angiogram, confirm that there's an inflammatory blush, and then we aim to reduce the blush. It's very important that we're not embolizing the actual parent genicular artery as the name seems to imply, which again goes back to why ortho, I think, initially balked at this procedure. The goal is actually not to embolize the genicular artery. The goal is to prune the neovascularity that grows in the setting of inflammation. What that really means is it's a very, very tiny amount of embolic.
I think when I first saw Okuno talk about this, he really stresses this and he continues to stress it. Once you start doing it, you understand why, because you have this-- We're trained to embolize. When you embolize, you take it to stasis and it requires a lot of embolic, usually. This is like the opposite of everything that we traditionally do, which is give a very tiny amount. You do an angiogram, you might still see a little blush and you're still tempted to give a little bit more, but as I've learned over time, really less is more and it's, again, you have to resist the urge to try to get this perfect pretty picture and trust that just a small amount of embolic will get the job done.
Once we've embolized all those arteries, we do a completion angiogram and then I just take the 4 French catheter out. I hold pressure where we punctured for about five to seven minutes, and then the patient goes to the recovery area. We watch them for usually about an hour and a half to two hours, and then they go home. If they were bilateral knee osteoarthritis, then I usually bring them back one to two weeks later. I just let them recover for a few days and we can talk about some of the post-procedure stuff. More often than not, they're in the hospital for only a few hours.
[Dr. Aaron Fritts]
Wow, that's amazing. It sounds like it's pretty streamlined.
[Dr. Osman Ahmed]
Yes. We, again, because a very brief practice is growing really fast, we typically try to do two or three procedures in a day, and I usually only-- I'm in that outpatient center only really in the morning, and I do clinic in the afternoon, so I usually can do those procedures. If we start on time at 8:00, usually by noon, we do two or three procedures, and I can go to clinic. I think we've gotten pretty efficient at it.
[Dr. Aaron Fritts]
Are you the only one at University of Chicago doing them or are there multiple providers?
[Dr. Osman Ahmed]
Yes, I think because the way this started was only getting a few consults at a time, and I really wanted to make sure that I could do enough where I sort of felt comfortable. I'm getting close to the point where I think I'll hopefully have done enough where I can start bringing in some other members and the bandwidth. As the practice grows, I won't have the bandwidth to do all the procedures. For right now I'm the only person, but I would anticipate very shortly over the next six months or so I'm going to try to start bringing a few of my partners to help and especially as we grow and expand into other joints.
(5) Embolic Tools in GAE
[Dr. Aaron Fritts]
Vascular anatomy is always a challenge, it can be very [crosstalk] obviously. Are there specific microcatheters or wires that you like in those cases, or do you feel like you can get the job done usually with your go-to?
[Dr. Osman Ahmed]
Yes, again, I've settled into a catheter and wire combination that works really well for me. For me specifically, and we talked about this a little at Gest MSK, I like the 4 French Glide C2 catheter. I like that angle. Sometimes it helps me actually get into those secures a little bit better. Then as far as microcatheter goes, I will usually interchange between a TruSelect and a Progreat Alpha. Then my wire of choice actually is the Asahi Chikai wire. I really like that wire particularly because a lot of these cases now I'm doing on a CRM in our hospital, that wire has a very radio opaque tip. I really like how easily I can see it and it shapes really well as well.
[Dr. Aaron Fritts]
Embolic materials. We see different things out there from different vendors. How has that evolved over time since you started doing this procedure?
[Dr. Osman Ahmed]
Yes, I think the choice of embolic is probably arguably the most exciting part of MSK embolization right now. I think it's the focus, as you know from recent MSK Gest meeting, that's really what a lot of people are talking about, is what's the ideal embolic, how much to give, what are the satisfactory endpoints, how many vessels to treat. I think the consensus seems to be that the field is moving towards temporary embolics or resorbable embolics. I don't think we're 100% there. We obviously have some compelling data to potentially suggest that permanent embolics work just as well and potentially may work better as reported by Matteo and his colleagues with the Gaucher trial.
For me, again, going back to my personality, I want to sort of learn and try a lot of things for myself to better understand. I started my practice doing primarily permanent microspheres, but ever since Marc Sapoval published the LipioJoint study, I've been fascinated by that. I've switched almost completely to Lipiodol contrast emulsion. I think we'll show a case here at the end, but it's been quite the journey with that. There's a little bit of a learning curve to that as well, but I've really enjoyed doing that. I think there's some particular advantages to that that, again, we can talk about, but that's what I've been doing most recently.
[Dr. Aaron Fritts]
Do some of the embolic materials have a learning curve to them where maybe it's good to start with something that you know and are used to if you're first starting out?
[Dr. Osman Ahmed]
Yes, that's a great question. I think if I look back, I would probably suggest to people, especially in the United States, to do microspheres. I think partially because that's what's FDA-approved for embolization. I think you have some sort of comfort there using an embolic that's on label for embolization at least. I think that resonates with patients a little bit for that reason. Then I think, like you mentioned, we're very comfortable using particles, obviously with PAE, UFE, tumor embolization, things like that. The learning curve there is much shorter. Again, as we talked about, it just takes a very tiny amount of embolic.
Then I think if you get comfortable with that, going with like Lipiodol emulsion, or even Imipenem, which is available in the United States, it can be done. I think there's some particular advantages in the sense that you can go to stasis. You don't have to worry about reflux and all these sorts of things. Again, I think there's other reasons to maybe consider not doing those just because they are newer, there's less data, all that sort of stuff.
[Dr. Aaron Fritts]
You do a fair amount of PAE as well, right?
[Dr. Osman Ahmed]
No, I actually don't do much PAE.
[Dr. Aaron Fritts]
Okay.
[Dr. Osman Ahmed]
That's the one frontier I haven't explored.
(6) Procedure Complexity & Complication Management
[Dr. Aaron Fritts]
No, I was just going to ask that maybe, because a lot of people who are maybe doing PAE in the outpatient space might be interested in this. I was really curious about like the level of difficulty, because you hear about PAE being challenging with varying anatomy and so forth, and especially with big prostates. What would you compare this to in terms of level of difficulty for somebody who's just starting out?
[Dr. Osman Ahmed]
Yes, that's a great question. I think maybe that's partially why I probably subconsciously not really explored PAE very much. I think PAE is one of the hardest procedures in IR. As you mentioned, the artery can be very small. The origin can be incredibly tortuous. The few PAEs I've done, I talked to my good friend, Nayan Parikh, he's one of the giants also in that field. I am always amazed how intricate that procedure can be. The reason I say all that is because I think GAEs, in a lot of ways, is the opposite.
I encourage every IR that's listening that is looking for a niche that GAE is a really good niche, I think, to pick up because it does help a lot of patients. There's a lot of patients out there that need this procedure. Then also just from a technical standpoint, I really don't think it's a hard procedure. I talked to a lot of people who are doing this and we all share the same sentiments. Yes. Maybe the first few cases are difficult, but after that you really settle in, the arteries are very reliably seen, and you can start doing these procedures really, really fast.
[Dr. Aaron Fritts]
Okay. Fantastic. The thing that everybody's always worried about is what kind of complications do we want to try and avoid here?
[Dr. Osman Ahmed]
Yes, definitely. I think because, again, this is where in the infancy of this procedure, it's really important that we focus on safety. I think as an academic, that's something we think about a lot. I would encourage people to think about safety, especially with a procedure that's new, that's not completely validated yet and where there's some skepticism outside of our field about. The way to, I think, ensure safety is to really be meticulous with your technique. Particularly, I think where docs will run into issues is with over embolization.
I think, again, really cautioning people to be using a very small amount of embolic. When I say small, we're talking 0.2 to 0.5 cc's. I, and I've seen some lectures from Okuno, for example, where he said, if you're using more than 3 cc's in a case, and he uses Imipenem which is a temporary agent, or at least primarily is Imipenem. If you're using more than 3 cc's in a case, you really need to stop and think what you're doing, meaning, making sure that you're not having some shunting or reflux or you're not seeing anything like that.
Even just a call to our own data, our study showed that, I think, if you used more than 2.5 or 2 cc's of embolic, the rate of skin discoloration and transient pain really increases a lot. If you're using more, it doesn't mean it's wrong, but it will potentially portend more complications. I think that's really the main thing.
Then the other thing I would say is really, as we'd sort of talked about earlier, really learn your anatomy, rely on your expertise as a interventional radiologist to know what the vessels are. There's a lot of overlapping vessels that essentially treat completely non-target areas. You can get fooled relatively easy, especially early on. If you have access to intra-procedural cross-sectional imaging, like cone beam CT or angio CT, I would encourage you to use that liberally until you get very comfortable with this procedure. I think those two things hopefully will keep you out of trouble.
[Dr. Aaron Fritts]
Yes. I was talking to a doc recently who's in the outpatient space who had a couple episodes of like skin changes around the knee and it freaked him out a little bit, got something back on the phone, figure out what to do. Any advice for that? Is that something to be expected on especially early days?
[Dr. Osman Ahmed]
Yes, definitely. I think that's another great point, is expectation management. I think just going back to the efficacy of the procedure, when I talk to patients, I tell them, look, this is not a cure. At least the literature doesn't suggest that this is a cure. We're going to improve your pain about 50%. At least that's the goal. We're going to achieve that in the majority of patients. Then when I talk to them about complications, I say, the side effects of this procedure are that invariably, there are tiny branches that go to the skin. Invariably, the majority of our patients will get some transient skin discoloration.
Now with microspheres, that's going to be much more common. Again, even if you use a small amount, everybody's going to get some, what looks like light bruising around their knee. If they know that, they don't freak out, you won't freak out. 99% of the time, almost probably actually 100% of the time, at least for me, fortunately, by one month it's all gone. As long as they know to expect that, I think that they're okay with that. This can obviously progress to ulceration, things like that. It is important that you follow those patients up and sort of make sure that that doesn't happen.
The other part of expectation or symptom management is you, more often than not, the first few days patients will get increased pain. I used to give everybody a steroid pack. I used to tell everybody give them narcotics or whatever. I think I've found that if you tell them you're going to get skin discoloration, you're going to get increased pain, it's going to last for a couple of days, they know that, they expect it. After that, they don't really need anything. I can actually just manage them with just even more conservatively. Don't even need to give them any additional pain medications outside of maybe like a Tylenol or something.
[Dr. Aaron Fritts]
Got it. It reminds me of like early days Y90 where you put like the ice pack over their belly. You ever do that over the knee?
[Dr. Osman Ahmed]
Yes. Sorry. Yes, that's the other thing. You brought up a good point. Yes, we also put ice packs. Again, like you said, just like the Y90 correlate with the falciform. I don't know if that's actually doing anything. It might be just treating us, but it's such a low-risk thing to do that we still do it for all of our patients, can't hurt kind of thing.
[Dr. Aaron Fritts]
Right. Constricts the blood vessels at the surface. Maybe it minimizes skin changes.
[Dr. Osman Ahmed]
Correct, exactly.
[Dr. Aaron Fritts]
You just need to see, yes, if anybody does a study around that or something.
[Dr. Osman Ahmed]
I have a nice angio CT, actually, of a descending genicular where you can see vessels going to the joint. Then you see these tiny, little arteries that you couldn't see on the angio going to the skin, but then we have our ice pack right over it, right on the side of the target. Again, I don't know how much it's helping or doing anything.
[Dr. Aaron Fritts]
Oz, anything else like post-procedural or any tips or tricks as we-- We're going to go over these cases here in a couple of minutes, but anything else that's essential, I think, for people starting to do this?
[Dr. Osman Ahmed]
Yes, definitely. If I could make a small little plea or pitch, I think, again, this is an easy practice to build, because there's so many patients out there that need this type of therapy. I encourage people to try to do this academically, meaning really try to follow your patients, really try to record the data. We're working, I think, tirelessly to try to get registries open, try to get sham studies in the United States going. There's other giants in our field in America, like Sid Padia, who are also doing this. When those opportunities show up, we're hoping that people out there that are sort of capturing this data can hopefully join in, whether they're in academia or in the outpatient space or anywhere in between.
Then, I think, just as far as tips and tricks go, I would encourage people to-- now enough people are doing it, that you can get advice and recommendations from a multitude of people. Everybody that I talk to does it a little bit differently. One big difference, I think, is a lot of people do retrograde pedal approach. I think for the PAD experts out there, that's an easy transition to do that. Obviously, patients probably prefer that as well. For me, I've found that the anatomy is a little more difficult and a lot more complex to come that way. Again, I think I encourage people to talk to people to figure out what angles work best for them.
[Dr. Aaron Fritts]
Yes. I was going to ask you about that, if you were to consider that, the typical, peel access, of course, you're worried about like the outflow of the foot. If they don't have any peripheral disease, they got a healthy dorsalis pedis, it seems like a short way to get there, but yes, the angles are could be tricky.
[Dr. Osman Ahmed]
Yes. I've only done it once, and maybe that's why. When I did it, I found that the angles were more difficult. It's actually longer, believe it or not, than coming from the SFA. That was another thing. I found that my catheter is barely reached. Again, that's the beauty of IR. You talk to anybody who does like a perm cath. We all do it differently, but we all get it done. It's like, I always tell my fellows and trainees, again, as long as you do it and you do it right, and the patient has what they were supposed to get and you didn't take like six hours doing it, I'm happy.
[Dr. Aaron Fritts]
Thank you. Especially for a perm cath.
[Dr. Osman Ahmed]
Five hours, that's okay.
[Dr. Aaron Fritts]
Yes. Right. Right. You just posted a shoulder on Twitter, I think, the other day. Also very cool. It's just amazing what we're seeing.
[Dr. Osman Ahmed]
It's amazing. I tell people when we talk about this. I feel like the knee is Pandora's box. I'm very focused on the knee. It's a very prevalent disease, but also a lot of the data is there. I think if we work really hard as a specialty to try to validate this intervention, I think that then opens up the door for all these other therapies, like adhesive capsulitis, plantar fasciitis, all these, basically sports injuries, soft tissue injuries, all that sort of stuff.
(7) Future Applications & Research in GAE
[Dr. Aaron Fritts]
Yes. Are we seeing more docs doing that in the US? I know Marc's been doing it in France, but are we seeing it catch on, even around the world?
[Dr. Osman Ahmed]
I think it's slowly starting to catch on or people are-- I think most people-- This is not why I post it on Twitter. I just posted it because I like to post interesting stuff, but people are reaching out and saying, oh, that's really cool. Why are you doing that? People don't know the data as much, obviously. Just sharing the study with them, people are very intrigued and interested by it. I'm trying to work with Gerbet to hopefully try to do some US-based studies to hopefully help validate the important work that Marc has done and try to get it, hopefully, like an on-label indication for that here as well would be awesome because I do think there's a lot of advantages to it.
[Dr. Aaron Fritts]
Fantastic. Oz, once again, thank you so much for coming on and sharing your expertise and these cases. If anybody needs to reach you or has any questions, is there a good way? You're on Twitter, obviously?
[Dr. Osman Ahmed]
Yes, definitely. No, first of all, thanks so much, Aaron. It really is. It's amazing that you considered to invite me back here despite [chuckles] all the nonsense that I say, but I appreciate it. Yes, people can reach out. However, my Gmail is pretty easy. It's osman, O-S-M-A-N, 1423@gmail.com. Then I think, as you mentioned, I'm pretty active on social media, so you can always message there as well. TheRealDoctorOs, O-S, not O-Z. Yes, I'm pretty accessible, so feel free to reach out anytime. I love talking about this stuff. As you probably know, could talk about it for hours.
[Dr. Aaron Fritts]
Yes, exactly. Perfect, Oz. Thank you so much. Thank you to our audience for listening. We'll catch you next time.
[Dr. Osman Ahmed]
Thank you, Aaron.
Podcast Contributors
Dr. Osman Ahmed
Dr. Osman Ahemd is an interventional radiologist at the University of Chicago and the chief medical officer of of FLOW Medical.
Dr. Aaron Fritts
Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.
Cite This Podcast
BackTable, LLC (Producer). (2024, September 20). Ep. 58 – Genicular Artery Embolization: How I Do It [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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