Management of Calcification: Rational and Technical Considerations for Intravascular Lithotripsy

Arterial calcification (AC) is a common complication among patients with peripheral arterial disease (PAD). AC presents various challenges to PAD treatment including an increased likelihood of vessel rupture and dissection, and by acting as a physical barrier to drug delivery by angioplasty balloons. Intravascular lithotripsy (IVL) is a novel intervention that specifically targets AC by emitting sonic pressure waves that introduce microfractures in target calcified lesions to increase arterial compliance. Preliminary data has demonstrated the safety and efficacy of IVL in PAD treatment. The present article provides a technical overview of S-IVL, as well as a case series of the treatment of AC in common iliac, common femoral, superficial femoral, aortoiliac, and peroneal arterial lesions. Each case resulted in marked improvement of luminal patency, exhibiting the efficacy IVL.