Stentless Intravascular Lithotripsy (IVL) for the Paravisceral Coral Reef Aorta: A Case Report

Coral reef aorta (CRA) is an obstructive disease characterized by heavy calcification of the paravisceral abdominal aorta, leading to impairment of visceral perfusion and exercise-limiting lower limb claudication. CRA is traditionally treated with open surgery through a retroperitoneal approach. In recent years, percutaneous angioplasty of the abdominal aorta, combined with open cell stenting or more complex stent-graft procedures, has been proposed as a less invasive alternative to open surgery, but the presence of heavy calcifications can be a relevant issue. The availability of the intravascular lithotripsy (IVL) technology allows for a more effective endovascular treatment of the aortic stenosis associated with significant calcifications. We report a case of a 55-year-old female patient presenting with bilateral exercise-limiting claudication and no palpable femoral pulses, secondary to paravisceral CRA. An endovascular treatment was performed using an IVL without stenting through a percutaneous right femoral artery access. Following the procedure, a significant improvement in the arterial pressure values was gained at the level of the distal aorta as a result of plaque remodeling. After 40 days, the patient has no recurrence of claudication. Duplex ultrasound confirms triphasic arterial waveforms at the level of the bilateral femoral artery. Although open surgery continues to be an effective procedure for CRA, IVL can be regarded as an attractive endovascular option when a less invasive procedure is required. A significant hemodynamic improvement can be achieved independently of stent placement. Further clinical experience is required to define the long-term role of this procedure.