Intravascular lithotripsy in infra-popliteal peripheral artery disease

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Endovascular Therapy

Background:

• Chronic limb-threatening ischemia (CLTI) often involves infra-popliteal (IP) arterial calcification, complicating revascularization.
• Extensively calcified, long occlusive lesions in IP arteries present significant challenges for endovascular treatment.

Purpose of the Study:

• To review the evidence on intravascular lithotripsy (IVL) for treating calcified peripheral arterial disease (PAD) in the IP segment.
• To assess the safety and efficacy of IVL in preparing calcified arteries for revascularization.

Main Methods:

• Systematic review of prospective studies and real-world data on IVL for IP arterial disease.
• Analysis of procedural success rates, vessel preparation, and adverse events associated with IVL.

Main Results:

• IVL demonstrates high procedural success rates and excellent vessel preparation in calcified IP lesions.
• Studies show low rates of major adverse events, highlighting the safety of IVL.
• IVL is versatile, effective in various PAD locations including iliac, femoropopliteal, and IP segments.

Conclusions:

• Intravascular lithotripsy is a safe and effective technology for treating calcified peripheral arterial disease.
• IVL facilitates revascularization in challenging CLTI cases with calcified IP arteries.
• Larger-scale studies are warranted to evaluate the long-term outcomes of IVL in PAD treatment.