Selective assisted intravascular lithotripsy for complex aorto-iliac calcific lesions

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Intravascular lithotripsy (IVL) is established for coronary and peripheral arteries.
• Evidence for IVL in the aortic district remains limited, with few reported cases.
• This study explores IVL's application in a complex infrarenal aortic occlusion.

Purpose of the Study:

• To report a case of intravascular lithotripsy for infrarenal aortic occlusion.
• To evaluate the feasibility and safety of IVL in treating severe calcific aortic lesions.
• To assess the outcome of IVL followed by stent grafting.

Main Methods:

• A case of infrarenal aortic occlusion with coral reef chronic occlusion was treated.
• Intravascular lithotripsy using a Shockwave M5+ balloon was employed.
• Aorto-iliac covered stenting in a kissing configuration followed IVL, preserving visceral and lumbar arteries.

Main Results:

• A single IVL balloon successfully and safely treated the heavily calcified aortic occlusion.
• The patient remained asymptomatic at 1 and 6 months post-procedure.
• Ultrasound confirmed patency of stent grafts and triphasic waveforms in common femoral arteries.

Conclusions:

• Selective intravascular lithotripsy is feasible for complex aortic and iliac calcific lesions.
• This case suggests IVL is a viable adjunct to stenting in challenging aortic cases.
• Further studies are needed to confirm long-term outcomes and support definitive conclusions.