Arian Taheri Amin, P. Minko
BACKGROUND: Transarterial microembolization (TAME) has become an increasingly established minimally invasive treatment option for chronic joint pain, particularly involving the knee joint. The procedural success of genicular artery embolization (GAE) is largely determined by the complex arterial anatomy, vascular variants and an extensive anastomotic network. OBJECTIVE: The aim of this review article is to describe the relevant target vessels for GAE. Special emphasis is placed on anatomical variants and anastomoses that influence target vessel selection, catheterization strategies and procedural safety of GAE. MATERIAL AND METHODS: Narrative literature review based on current angiographic, anatomical and clinical studies on GAE, focusing on arterial anatomy, anatomical variants and the functional relevance of the anastomotic network. RESULTS: In the knee, the descending genicular artery (GA), superomedial GA, inferomedial GA, superolateral GA, inferolateral GA and the anterior recurrent tibial artery are identified as key target vessels. These arteries show substantial interindividual variability and extensive anastomotic connections. This vascular network explains why embolization of a single genicular artery does not provide a clinical benefit over placebo and why treatment of all GAs is required. DISCUSSION: The clinical success of GAE greatly depends on a thorough understanding of vascular anatomy. A structured approach to target vessel selection, with detailed knowledge of anatomical variants and anastomoses, is essential for a safe, complete and effective GAE.