Intravascular Lithotripsy For Severe Peripheral Artery Calcification – A 3-Year Single Centre Experience

Abstract

Introduction: Severe arterial calcification is a challenging limitation in endovascular procedures leading to worse success rates and outcomes. Conventional balloon angioplasty may provide limited luminal gain, calling for adjunctive strategies of plaque modification, such as intravascular lithotripsy (IVL). The aim of this study is to describe our institutional experience with IVL in the treatment of peripheral artery disease (PAD).
Materials and methods: A prospectively maintained database from a tertiary academic medical centre was retrospectively enquired from October 2021 to September 2024. The study included all patients who underwent IVL (Shockwave Medical, Inc., California, USA) for vessel preparation during endovascular treatment of PAD.
Results: 19 patients were included (79% male, median age 76 years) with a median follow-up period of 6 and total of 35 months. Most common risk factors were hypertension (90%), diabetes (68%), dislipidemia (63%) and ischaemic heart disease (63%). Clinical presentation was mostly chronic limb-threatening ischemia (Fontaine grade IV in 74% and Fontaine grade III in 10%). The target lesion undergoing IVL was most often femoropopliteal (68%). Intraprocedural lesion crossing was almost equally subintimal and intraluminal (53% vs. 47%) and definitive treatment was mostly performed with stenting (79%). Additionally, 3 patients (16%) underwent a hybrid procedure with femoral endarterectomy (11%) or femoro-femoral bypass (5%). There were no identified procedural complications. Major adverse limb events (MALE) included no reinterventions and 1 major amputation (5%), and the all-cause mortality rate was 16%. Regarding the 14 patients in Fontaine grade IV, the wound healing rate was 57%.
Discussion/Conclusion: IVL is a safe and effective adjunctive in vessel preparation during endovascular revascularisation procedures, particularly in the femoropopliteal sector. Procedure and/or device-related complications, MALE and mortality are infrequent. Further research is needed concerning aortoiliac and infrapopliteal sectors and comparison with other supplementary treatment alternatives.