Dr. Aaron Fischman  /  Genicular Artery Embolization

Genicular Artery Embolization
(GAE) for Knee Pain in New York City

A knee arthritis treatment without knee replacement — a minimally invasive, same-day procedure for chronic knee pain from osteoarthritis, from a knee replacement that still hurts, or from recurrent bleeding into a replaced knee. No surgery, no general anesthesia. Performed by a leading interventional radiologist at Mount Sinai.

Request a Consultation Learn About GAE ↓
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Mount Sinai, NYCLeading IR center for joint pain
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Foot-First AccessClosest route to the knee
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Hundreds of CasesExperienced GAE specialist
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Castle ConnollyTop Doctor — 8 Consecutive Years

Overview

What Is Genicular Artery
Embolization (GAE)?

Genicular artery embolization (GAE) is a minimally invasive, catheter-based procedure that treats chronic knee pain caused by osteoarthritis. It works by targeting the abnormal blood vessels — called neovascularization — that develop around the arthritic knee and help drive persistent inflammation and pain signals.

In a healthy joint, blood vessel growth is regulated. In osteoarthritis, abnormal new vessels grow into the joint lining (synovium) alongside nerve fibers, amplifying pain. GAE uses a catheter to deliver an embolic agent — temporary or permanent, depending on the indication — that selectively reduces these abnormal vessels, interrupting the inflammatory pain cycle without touching the joint itself.

The procedure is performed entirely through a small puncture — most often in the foot or ankle, the access point closest to the knee, and otherwise in the groin or wrist — under mild sedation and real-time X-ray imaging guidance. There is no surgical incision, no general anesthesia, and no joint replacement required. Patients go home the same day and typically return to normal activities within a few days.

GAE does not cure osteoarthritis, but pooled data show meaningful pain reduction maintained at 12 months in most treated patients[1,2] — making it a non-surgical option for patients seeking knee pain relief in New York without, or before, joint replacement. The same technique also treats persistent pain and recurrent bleeding after knee replacement.

~80% Clinical Response Rate

Pooled analysis: roughly 78–92% of patients reached clinically meaningful improvement by 12 months[2].

Same Day Discharge

Patients go home the same day — no overnight hospital stay, no surgical wound.

~1 hr Typical Procedure Time

GAE is performed as an outpatient procedure under mild sedation with rapid recovery.

Foot First Access

Most knee cases are done through a pinhole at the foot or ankle; groin or wrist when anatomy favors it.

Side-by-side illustration: an osteoarthritic knee with inflamed synovium, abnormal neovessels, and nerve ingrowth, and the same knee after genicular artery embolization with calmer synovium and preserved main genicular arteries
Left: the inflammatory cycle in an arthritic knee — inflamed lining, abnormal new vessels, and nerve ingrowth. Right: after GAE, the abnormal vessels are reduced while the main genicular arteries remain open. Illustration for patient education; the embolic agent is depicted as particles for simplicity.

Why Dr. Fischman

Why Choose Dr. Fischman
for GAE in New York City?

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Hundreds of GAE Cases

Dr. Fischman is one of the most experienced GAE operators in the United States, having performed hundreds of genicular artery embolization procedures, most through the foot — the access point closest to the knee.

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130+ Peer-Reviewed Publications

A prolific clinical researcher with over 130 peer-reviewed publications, Dr. Fischman's academic work spans embolization techniques, outcomes research, and minimally invasive innovation across interventional radiology.

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Mount Sinai Center of Excellence

Procedures are performed at Mount Sinai Health System — one of the nation's leading academic medical centers — with full imaging, anesthesia, and post-procedure support infrastructure.

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Trains Physicians Worldwide

As Program Director of IR Residency at Mount Sinai, Dr. Fischman trains the next generation of interventional radiologists and lectures internationally on embolization techniques including GAE.

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Castle Connolly Top Doctor

Recognized as a Castle Connolly Top Doctor for 8 consecutive years — a distinction awarded based on peer nominations and reflecting sustained excellence in patient care and clinical outcomes.

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Telemedicine for Out-of-State Patients

Dr. Fischman regularly sees patients from across the United States and internationally. Initial consultations are available via telemedicine, and GAE is a same-day outpatient procedure — many patients travel to NYC and return home the next day.

📄 Published Research → 🏥 Mount Sinai Profile → ↗ Also Performs PAE for BPH →

Conditions Treated

Knee Conditions Dr. Fischman
Treats with GAE

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Knee Osteoarthritis

The most common reason for GAE and the indication with the most research. GAE is an option when physical therapy, weight management, anti-inflammatory medications, and injections have not provided lasting relief. Patients with mild-to-moderate arthritis tend to respond best[6].

Symptoms Addressed

  • Chronic knee pain with activity
  • Pain at rest or at night
  • Swelling and stiffness
  • Short-lived relief from injections
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Pain After Knee Replacement

Some patients still have pain months to years after a technically successful knee replacement. Once loosening, infection, and mechanical problems are ruled out, inflamed tissue around the implant can be treated with GAE. Early series report average pain falling from about 7–8 to about 3 out of 10[7,8].

Symptoms Addressed

  • Persistent pain despite a well-fixed implant
  • Warmth or swelling around the replaced knee
  • Pain limiting rehabilitation
  • No surgical cause identified
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Bleeding After Knee Replacement

Recurrent hemarthrosis — repeated bleeding into a replaced knee — is an uncommon but frustrating problem. Embolizing the bleeding genicular branches is an established, non-surgical fix: a systematic review of 214 cases reported symptom improvement in about 73%, and some patients need a second treatment[9,10].

Symptoms Addressed

  • Sudden, repeated swelling of the replaced knee
  • Bloody fluid on aspiration
  • Pain and stiffness during bleeding episodes
  • Failure of rest, bracing, or aspiration

Shoulder, elbow, hand, hip, heel, or Achilles pain? Dr. Fischman treats frozen shoulder, tennis elbow, thumb and hip arthritis, plantar fasciitis, and Achilles tendinopathy with musculoskeletal embolization.

Musculoskeletal Embolization →

Patient Experience

★★★★★
“Dr. Fischman and GAE literally saved my life! Not only is he a consummate professional, but he's also a genius! Moreover, he's kind, funny, personable and his staff is A+++! I literally couldn't walk — and on October 7, 2024 Dr. Fischman did the GAE procedure on my right knee and gave me back my life!!!”
Elizabeth I. · Google Review

Read more patient reviews on Google →

The Procedure

What to Expect on the Day of GAE

1

Consultation & Imaging Review

Dr. Fischman reviews your symptom history, prior imaging (X-rays and MRI), and treatment history to confirm you are a GAE candidate and plan the approach. Telemedicine consultations are available for out-of-state and international patients.

2

Access & Angiography

Under mild sedation and local anesthesia, a catheter is introduced through a small puncture — most often in the foot or ankle (tibial artery), and otherwise in the groin or wrist when anatomy favors it. Using real-time fluoroscopic imaging and contrast dye, Dr. Fischman maps the abnormal neovascular supply to the affected joint with precision before embolization.

3

Embolization

An embolic agent — temporary or permanent, depending on the indication — is selectively delivered to the abnormal vessels driving joint inflammation or bleeding. Healthy vessels and surrounding structures are preserved. The goal is targeted reduction of neovascular tissue — not elimination of all blood supply to the joint.

4

Same-Day Discharge

You recover briefly on-site and go home the same day. Most patients return to light activities right away. Initial mild soreness around the treated joint is normal and typically resolves within a week. Pain reduction is gradual over 4–8 weeks as inflammation subsides.

Recovery Timeline

Day 1
Rest. Mild soreness or warmth around the treated joint is expected and normal.
Day 2+
Return to light daily activities. Avoid strenuous impact activity on the treated joint.
Weeks 4–8
Meaningful pain reduction as neovascular tissue resolves. Improved function and mobility reported by most patients.
Months 3–12+
In published series, most patients who improve maintain their benefit at 12 months. GAE can be repeated if symptoms return.

The Research

What the Evidence Shows

Professional society position · May 2026

The Society of Interventional Radiology (SIR) published a position statement describing GAE as a targeted, joint-preserving option for symptomatic knee osteoarthritis in patients who have not improved with conservative treatment and are not candidates for, or wish to delay, knee replacement. The statement also calls for larger randomized trials to build on the current evidence[13].

Knee osteoarthritis

  • A 2026 meta-analysis of 18 studies (534 patients) found average pain reductions of about 4 to 4.5 points on a 10-point scale, sustained from 1 through 12 months[1].
  • A 2025 meta-analysis reported clinically meaningful improvement in roughly 78–92% of patients by 12 months[2].
  • Mild arthritis responded better than moderate-to-severe arthritis (81.8% vs 36.4% responders at 6 months)[6].
  • In the 2026 GAUCHO randomized trial (60 patients), a temporary embolic (imipenem/cilastatin) and permanent microspheres produced similar pain and function improvement through 12 months, with no major difference in adverse events[12].

Sham-controlled trials: mixed results

The first multicenter sham-controlled trial found significantly greater pain reduction with GAE than sham at one month[3]. Two later sham-controlled trials found that both groups improved substantially, with no statistically significant difference between them[4,5] — evidence of a large placebo effect in knee pain research. Larger randomized trials are underway. Dr. Fischman discusses this openly during consultation.

After knee replacement

  • Persistent pain: in a multicenter series, average pain fell from 7.0 to 3.4 out of 10, and 62.5% of patients had at least a 50% reduction at 6 months[7]. A prospective series of 37 patients reported pain falling from 8.1 to 3.1 at 3 months[8].
  • Recurrent hemarthrosis: in 56 patients, bleeding resolved in 64% after one embolization and 79% after a second[10].

Safety & future surgery

Serious complications are uncommon; temporary skin discoloration and soreness are the most frequent side effects. In a multicenter study of 48 knee replacements performed after GAE, 8.3% had minor wound or incision issues, all of which resolved[11]. GAE does not prevent a future knee replacement.

GAE vs. Other Treatments

How Does GAE Compare
to Other Options?

Patients with chronic knee pain from osteoarthritis typically progress through a treatment ladder — from medications and physical therapy, to injections, to surgery. GAE sits at a critical point on that ladder: after conservative measures have failed but before committing to joint replacement. It offers meaningful pain relief without the risks, recovery, or permanence of surgery.

GAE
Dr. Fischman · Mount Sinai		 Steroid Injection Joint Replacement
Surgical Incision ✓ None None Major incision required
Anesthesia ✓ Mild sedation only Local only General or spinal
Hospital Stay ✓ Same-day discharge In-office 2–4 day inpatient stay
Recovery Time ✓ 3–5 days Immediate 3–6 months
Duration of Relief ✓ Often 12+ months in studies 4–12 weeks typically Long-term (permanent)
How It Works ✓ Targets inflamed joint lining Temporarily reduces inflammation Replaces joint entirely
Repeatable ✓ Yes if needed Limited (3–4x/year max) Revision possible but complex
Preserves Natural Joint ✓ Yes Yes No — joint is replaced

Individual outcomes vary. This comparison is for informational purposes only. Dr. Fischman will discuss your specific case and the most appropriate treatment options during your consultation.

Patient Selection

Am I a Candidate for GAE
in New York City?

GAE may be appropriate for you if you meet one or more of the following criteria. Dr. Fischman evaluates each patient individually at Mount Sinai, reviewing imaging and clinical history before recommending any procedure.

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    Knee osteoarthritis confirmed by imaging (X-ray or MRI)
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    Chronic knee pain lasting more than 3–6 months that significantly affects daily function or quality of life
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    Inadequate or short-lived relief from conservative treatments — physical therapy, NSAIDs, or steroid injections
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    Desire to avoid or delay joint replacement surgery
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    Not yet a surgical candidate due to age, weight, or medical comorbidities
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    Mild to moderate osteoarthritis tends to respond best; advanced arthritis is evaluated case by case
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    Failure of PRP (platelet-rich plasma) or hyaluronic acid injections to provide lasting relief
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    Persistent pain or recurrent bleeding after knee replacement, with loosening and infection ruled out

Schedule a Consultation

Dr. Fischman's team will review your imaging, symptom history, and prior treatments to determine whether GAE is appropriate for you. Telemedicine consultations are available for patients outside New York and international patients.

Office: Mount Sinai Health System
5 East 98th Street, 12th Floor
New York, NY 10029

Phone: (212) 241-4046

Request a Consultation

Insurance

Insurance coverage for GAE varies. Some plans cover GAE for knee osteoarthritis; others still consider it investigational. Dr. Fischman's team will perform a detailed insurance review and prior authorization assessment before your procedure so there are no surprises.

See It in Action

GAE at Mount Sinai —
Watch the Procedure

Dr. Fischman walks through genicular artery embolization — how the procedure works, what patients can expect, and why GAE offers a meaningful alternative to joint replacement for appropriately selected patients with osteoarthritis.

More videos available on @AaronFischmanMD on YouTube

Frequently Asked Questions

Common Questions About GAE

Yes. Genicular artery embolization (GAE) is a non-surgical knee arthritis treatment for people whose pain has not improved with physical therapy, medications, or injections and who are not ready for, or not candidates for, knee replacement. It is done through a pinhole in the foot or groin, without general anesthesia, and patients go home the same day. The Society of Interventional Radiology's 2026 position statement describes GAE as a joint-preserving option for appropriately selected patients. GAE does not repair cartilage, and some patients with advanced arthritis will still need a knee replacement, which remains possible after GAE. Dr. Fischman performs GAE at Mount Sinai in New York City.

In an arthritic knee, abnormal new blood vessels (neovascularization) grow into the inflamed joint lining, and small nerve fibers grow in alongside them. These vessels help sustain inflammation and amplify pain signals. GAE uses a tiny catheter to deliver an embolic agent into the small genicular artery branches feeding that abnormal tissue. As the abnormal vessels are reduced, the inflammatory pain cycle can settle. The main arteries of the knee are preserved.

In published studies, most patients who improve after GAE maintain their improvement at 12 months, and a pooled analysis reported clinically meaningful improvement in roughly 78–92% of patients by 12 months. Results are better in mild-to-moderate arthritis than in advanced arthritis. GAE does not stop the underlying arthritis, and if symptoms return the procedure can be repeated in appropriate candidates.

Yes. Prior steroid, hyaluronic acid, or PRP injections do not disqualify you from GAE. GAE is often considered precisely because injections provided only short-lived relief. Dr. Fischman will review your full treatment history during consultation.

For some patients, GAE provides enough relief to delay knee replacement, and for patients who are not good surgical candidates it can be a longer-term strategy. Because GAE treats pain rather than the structural arthritis, some patients with advanced disease will still need a knee replacement. In a multicenter study of patients who had knee replacement after GAE, complications were uncommon and all resolved, so GAE does not close the door on future surgery.

Yes, in two situations. Some patients have persistent pain after knee replacement even though the implant is well fixed and there is no infection; early studies of GAE in this group report meaningful pain reduction in many patients. Other patients develop recurrent bleeding into the knee (hemarthrosis) after replacement; embolization of the bleeding branches resolves the problem in most patients, sometimes after a second treatment. Dr. Fischman works with your orthopedic surgeon to rule out loosening, infection, and mechanical causes first.

Dr. Fischman most often works through a small puncture in the foot or ankle (the tibial artery), which is the access point closest to the knee. When anatomy favors a different route, he uses the groin (femoral artery) or, less commonly, the wrist (radial artery). There is no incision and no stitches.

Serious complications are uncommon in published studies. The most common side effects are temporary soreness around the knee and temporary skin discoloration over the treated area, which usually resolves on its own. As with any catheter procedure, there is a small risk of bruising at the access site. Dr. Fischman uses careful angiographic mapping before embolization to avoid non-target vessels, and he reviews the specific risks with you during consultation.

Insurance coverage varies. Some commercial plans cover GAE for knee osteoarthritis, while others still classify it as investigational; Medicare coverage depends on region and clinical circumstances. Dr. Fischman's team at Mount Sinai verifies your benefits and pursues prior authorization before scheduling, and reviews any out-of-pocket cost with you in advance. Call (212) 241-4046 to begin.

Results are mixed. The first multicenter sham-controlled trial found significantly greater pain reduction with GAE than with a sham procedure at one month. Two later sham-controlled trials in patients with mostly mild-to-moderate arthritis found that both groups improved substantially, with no statistically significant difference between them, which points to a large placebo effect in knee pain studies. Larger randomized trials are underway. Dr. Fischman discusses this evidence openly so you can decide whether GAE is right for you.

Yes. Dr. Fischman sees patients from across the United States and internationally. Initial consultations can be done by telemedicine, and GAE is a same-day outpatient procedure, so many out-of-state patients return home the same day or the next morning.

Radiofrequency ablation (RFA) disables the sensory nerves that carry pain signals from the knee. GAE works upstream by reducing the abnormal vessels that sustain inflammation in the joint lining. RFA is performed with needles placed near specific nerves; GAE is performed through a catheter in the arteries. Both are non-surgical, and some patients who do not respond to one benefit from the other. Dr. Fischman will help determine which approach, or combination, fits your situation.

References

Peer-Reviewed Sources

  1. Alves LH, et al. Genicular artery embolization as a minimally invasive treatment for knee osteoarthritis: systematic review and meta-analysis. Skeletal Radiol. 2026. Epub ahead of print. doi:10.1007/s00256-026-05340-x
  2. Abussa R, et al. Bridging the gap between injections and surgery: meta-analysis of genicular artery embolization in knee osteoarthritis. Acad Radiol. 2025;32(11):6796-6811. doi:10.1016/j.acra.2025.05.011
  3. Bagla S, et al. Multicenter randomized sham controlled study of genicular artery embolization for knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2022;33(1):2-10.e2. doi:10.1016/j.jvir.2021.09.019
  4. Landers S, et al. Genicular artery embolization for early-stage knee osteoarthritis: results from a triple-blind single-centre randomized controlled trial. Bone Jt Open. 2023;4(3):158-167. doi:10.1302/2633-1462.43.BJO-2022-0161.R2
  5. van Zadelhoff TA, et al. Genicular artery embolisation versus sham embolisation for symptomatic osteoarthritis of the knee: a randomised controlled trial. BMJ Open. 2024;14(10):e087047. doi:10.1136/bmjopen-2024-087047
  6. Gill SD, et al. Outcomes after genicular artery embolization vary according to the radiographic severity of osteoarthritis: results from a prospective single-center study. J Vasc Interv Radiol. 2023;34(10):1734-1739. doi:10.1016/j.jvir.2023.06.016
  7. Bertoni HG, et al. Genicular artery embolization for persistent pain after total knee arthroplasty: initial clinical experience. J Vasc Interv Radiol. 2026;37(3):107932. doi:10.1016/j.jvir.2025.107932
  8. Konduru N, et al. Genicular artery embolization as a treatment option for refractory knee pain post total knee arthroplasty: a prospective series. Cardiovasc Intervent Radiol. 2026;49(7):1384-1390. doi:10.1007/s00270-025-04318-x
  9. Melian CM, et al. Geniculate artery endovascular embolization post-total knee arthroplasty for hemarthrosis treatment: a systematic review of the literature. J Endovasc Ther. 2024;31(6):1158-1164. doi:10.1177/15266028231157642
  10. Sirola SM, et al. Treating recurrent hemarthrosis after knee arthroplasty with selective embolization: a cohort study of 56 patients. Acta Orthop. 2025;96:33-37. doi:10.2340/17453674.2024.42660
  11. Albrecht H, et al. Safety of knee arthroplasty following genicular artery embolization for knee osteoarthritis. Cardiovasc Intervent Radiol. 2025;48(12):1795-1800. doi:10.1007/s00270-025-04227-z
  12. Correa MP, et al. Genicular artery embolization using imipenem/cilastatin vs. microsphere for knee osteoarthritis (GAUCHO): 12-month clinical results of a single-blind randomized controlled trial. Cardiovasc Intervent Radiol. 2026;49(9):1825-1837. doi:10.1007/s00270-026-04504-5
  13. Ahmed O, et al. Society of Interventional Radiology position statement on genicular artery embolization for symptomatic knee osteoarthritis. J Vasc Interv Radiol. 2026;37(7):108803. doi:10.1016/j.jvir.2026.108803

Dr. Fischman Also Treats

Other Minimally Invasive Procedures

Joint or tendon pain elsewhere? Many of the same principles apply. Explore what else Dr. Fischman treats at Mount Sinai.

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Prostate Artery Embolization (PAE) for Enlarged Prostate

A minimally invasive, same-day procedure for benign prostatic hyperplasia (BPH) — no surgery, no general anesthesia, and a low risk of sexual side effects. Performed through the wrist at Mount Sinai.

Learn about PAE →
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Shoulder · Elbow · Hand · Hip · Foot

Musculoskeletal Embolization Beyond the Knee

Frozen shoulder, rotator cuff pain, tennis elbow, thumb and hip arthritis, plantar fasciitis, and Achilles tendinopathy.

Learn more →

Living with Chronic Knee Pain? GAE May Help.

Schedule a consultation with Dr. Fischman at Mount Sinai, New York City — in person or via telemedicine.

Request a Consultation (212) 241-4046
Aaron M. Fischman, MD, FSIR, FCIRSE, FSVM Interventional Radiology
5 E 98th Street, 12th Floor New York NY 10029 US
(212) 241-4046