What to Expect Before, During and After a GAE Procedure
Knowing What to Expect Makes the Entire Experience Easier
Genicular artery embolization is a procedure that many patients in Lahore encounter for the first time when their orthopaedic surgeon or interventional radiologist presents it as an option for chronic knee pain. The concept of a catheter-based procedure targeting blood vessels around the knee can sound complex and unfamiliar. In practice, the patient experience is straightforward, the discomfort is minimal, and the recovery is dramatically faster than any surgical alternative. Understanding what happens at each stage — before, during, and after — removes the uncertainty that causes unnecessary anxiety and helps patients arrive prepared and confident.
At Alnoor Diagnostic Centre in Shadman, Lahore, we guide every GAE patient through the process with clear communication and attentive care from the initial consultation to post-procedural follow-up.
Before the Procedure — Preparation and Assessment
Initial consultation and imaging review — The process begins with a thorough consultation with our interventional radiologist. Your knee MRI and any other relevant imaging are reviewed to confirm that active synovial inflammation is present and that your osteoarthritis is at the appropriate stage for GAE. Your clinical history, previous treatments, and overall medical health are assessed. This step is not a formality — it is the clinical foundation that determines whether GAE is genuinely appropriate for your specific situation and what outcomes are realistic to expect.
Blood tests and pre-procedural investigations — Before the procedure, routine blood tests are performed to check kidney function — because contrast dye used during fluoroscopy is cleared by the kidneys — and to assess clotting function. If you are on blood-thinning medications such as warfarin, clopidogrel, or newer anticoagulants, specific instructions will be given about when to pause these medications before the procedure. Never adjust blood-thinning medication without explicit guidance from your interventional radiologist.
Fasting instructions — You will be asked to fast for four to six hours before the procedure. This is a standard precautionary measure for any procedure involving sedation, even though GAE is performed under local anaesthesia with only mild sedation in most cases. You may take essential regular medications with a small sip of water on the morning of the procedure unless specifically instructed otherwise.
Practical arrangements — Arrange for a responsible adult to accompany you to the centre and take you home afterward. Although most patients feel well shortly after GAE and can walk comfortably, driving on the day of the procedure is not advisable. Wear loose, comfortable clothing — particularly loose trousers or clothing that allows easy access to the groin area where the arterial puncture will be made. Leave jewellery and valuables at home.
During the Procedure — What Actually Happens
Arrival and preparation — When you arrive at the interventional radiology suite, the nursing team confirms your identity, reviews your medical history, and establishes an intravenous line in your arm through which sedation and any other medications can be administered. Your vital signs are recorded and monitoring equipment is attached.
Positioning and local anaesthesia — You are positioned lying on the angiography table. The skin over the access site — typically the femoral artery in the groin — is cleaned and sterile drapes are applied. Local anaesthetic is injected into the skin and underlying tissue at the puncture site. This injection produces a brief stinging sensation that resolves within seconds. Beyond this, the procedure itself involves no significant pain because the arteries have no pain receptors.
Arterial access and catheter navigation — A small needle is introduced into the femoral artery under ultrasound guidance, followed by a thin plastic sheath through which all subsequent instruments pass. The interventional radiologist then advances a catheter through this sheath under fluoroscopic guidance — watching its position on the real-time X-ray screen — and navigates it toward the genicular arteries surrounding the knee. Contrast dye injected through the catheter fills the vessels and makes them visible on fluoroscopy, creating the angiographic roadmap that identifies which vessels are abnormal and require treatment.
Embolization — A microcatheter is advanced through the larger catheter into the specific abnormal vessels identified on angiography. Tiny microsphere particles are delivered precisely through this microcatheter to block the abnormal neovascular vessels sustaining synovial inflammation. The interventional radiologist treats each target vessel systematically, confirming the embolization result angiographically after each treatment. The entire procedure takes approximately one to two hours depending on the complexity of the vascular anatomy.
What you will feel — Throughout the procedure most patients feel very little beyond mild pressure sensations as catheters are moved. Some patients feel a brief warmth around the knee when contrast is injected — this is normal and passes quickly. Mild sedation keeps you relaxed without rendering you unconscious. You remain able to communicate with the team throughout and will be kept informed of progress.
After the Procedure — Recovery and Pain Relief
Immediate recovery — After the catheters are removed, gentle pressure is applied to the groin puncture site for fifteen to twenty minutes to ensure the artery seals properly. You are then moved to the recovery area where your vital signs, puncture site, and general comfort are monitored for one to two hours. Most patients feel well enough to sit up and take light refreshments within an hour of the procedure completing.
Same-day discharge — The majority of GAE patients are discharged the same day. You will be given clear written instructions about puncture site care, activity restrictions for the first 24 hours, what symptoms to watch for, and when to contact the centre if any concerns arise. Avoid strenuous activity and heavy lifting for 48 hours following the procedure. The groin puncture site should be kept dry for 24 hours and inspected for any unusual swelling or bruising.
Expected sensations in the first days — Mild aching around the knee in the first 24 to 72 hours is normal and expected. It reflects the tissue response to the reduction in blood supply to the treated synovial vessels. Simple oral pain relief manages this comfortably in the vast majority of patients. Some patients notice a small area of skin discolouration around the knee — a transient change that resolves spontaneously without any treatment within a few weeks.
When does the pain relief start? — This is the question patients ask most eagerly after the procedure. Pain relief from GAE is not immediate — it develops gradually over two to eight weeks as synovial inflammation reduces following the interruption of its abnormal blood supply. Patients who expect instant results after GAE will be disappointed. Patients who understand that the biological process of inflammation resolution takes time will find the gradual improvement over the following weeks both noticeable and encouraging. Most patients report meaningful improvement in pain and function by six to eight weeks post-procedure.
Follow-up — A follow-up appointment is scheduled at six to eight weeks to assess your response to treatment, review any symptoms, and discuss whether any additional management is required. Further imaging may be requested at this stage if clinically indicated.