Stentless Intravascular Lithotripsy (IVL) for the Paravisceral Coral Reef Aorta: A Case Report
Raoul Borioni1, Alessandra Rinaldi Garofalo1, Maria Chiara Tesori1
1Vascular Surgery, Aurelia Hospital, Rome, ITA.
Insights
Intravascular lithotripsy (IVL) offers a less invasive treatment for coral reef aorta (CRA), a condition causing leg pain due to aortic calcification. This technique effectively remodels calcified plaques, improving blood flow without stenting.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Coral reef aorta (CRA) is a severe obstructive disease of the paravisceral abdominal aorta, marked by extensive calcification.
- This calcification impairs visceral perfusion and causes exercise-limiting lower limb claudication, traditionally managed with open surgery.
- Percutaneous endovascular techniques are emerging alternatives, but heavy calcifications pose a significant challenge.
Observation:
- A case report details a 55-year-old female patient with bilateral exercise-limiting claudication due to paravisceral CRA.
- The patient presented with no palpable femoral pulses, indicating severe arterial obstruction.
- An endovascular approach was chosen for treatment.
Findings:
- Intravascular lithotripsy (IVL) was employed without stenting via a percutaneous right femoral artery approach.
- The IVL procedure resulted in significant plaque remodeling and improved arterial pressure in the distal aorta.
- Post-procedure, the patient experienced no recurrence of claudication, with duplex ultrasound confirming restored triphasic arterial waveforms in the femoral arteries.
Implications:
- IVL presents a promising, less invasive endovascular option for managing coral reef aorta, particularly in cases with significant calcifications.
- Hemodynamic improvement can be achieved with IVL independently of stent placement.
- Further clinical studies are necessary to establish the long-term efficacy and role of IVL in CRA treatment.
Abstract:
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.
