Virginia Research Day 2025

Medical Student Research Case Reports

35 Arteriovenous Fistula Identified and Treated Prior to Geniculate Artery Embolization

Cassandra Pfeiffer, BS, MS; Tony Rizk, DO Corresponding author: cpfeiffer@vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus Medical University of South Carolina

Osteoarthritis (OA) is the most prevalent joint pathology worldwide, characterized by articular cartilage degeneration, joint pain, stiffness, and functional limitations that significantly impact quality of life. The treatment of OA is multifactorial and aimed primarily at symptom alleviation and slowing disease progression, with patients often opting for non-surgical interventions such as weight loss, physical therapy, anti-inflammatory medications, and platelet-rich plasma (PRP) injections. Geniculate artery embolization (GAE) has recently emerged as a promising minimally invasive treatment for knee OA, particularly for patients who are either poor surgical candidates or prefer to avoid joint

replacement surgery. GAE targets the geniculate arteries that supply the knee joint, aiming to reduce hypervascularization and neovascularization, which are commonly present in OA-affected synovium and subchondral bone, thereby decreasing pain and inflammation. The procedure requires a detailed understanding of the vascular anatomy, as geniculate artery variations can affect both pre-operative planning and intra-operative outcomes. In this case report, a diagnostic angiogram revealed hyperemia of the superomedial and inferomedial geniculate arteries in a patient with moderate OA and left knee pain. Additionally, an incidental arteriovenous fistula (AVF) was identified in the inferomedial geniculate artery,

likely iatrogenic due to a prior medial meniscectomy. AVFs are a known complication of arthroscopic surgery and pose a risk of non-target embolization, which could lead to severe complications such as pulmonary embolism. To mitigate this risk, the AVF was treated with superselective coil embolization before proceeding with the GAE. The embolization of the hyperemic geniculate arteries with microspheres resulted in significant post-procedural pain relief for the patient. This case highlights the importance of recognizing potential vascular complications in OA patients undergoing GAE, particularly in those with a history of prior joint surgery.

127 2025 Research Recognition Day