Intravascular Lithotripsy for Coral Reef Aorta and Chronic Mesenteric Ischemia: Case Report and Comprehensive
Dipankar Mukherjee1, Bibhas Amatya2, David J Spinosa3,4
1Division of Vascular Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USA.
Insights
Intravascular lithotripsy (IVL) offers a less invasive option for treating chronic mesenteric ischemia (CMI) caused by severe paravisceral atherosclerosis. This approach successfully restored blood flow and resolved symptoms in a complex case, adding to evidence for IVL in visceral interventions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Therapy
Background:
- Chronic mesenteric ischemia (CMI) from extensive paravisceral atherosclerosis presents a significant challenge, especially for patients unsuitable for traditional surgical bypass due to severe calcified vascular disease.
- Endovascular techniques are emerging as less invasive alternatives for managing complex atherosclerotic conditions affecting visceral arteries.
Purpose of the Study:
- To describe the successful application of intravascular lithotripsy (IVL) in a patient with near-total paravisceral aortic occlusion causing CMI.
- To review existing literature on IVL use in visceral and paravisceral arterial interventions.
Main Methods:
- A multidisciplinary, endovascular-first strategy was employed, integrating IVL, angioplasty, and embolic protection.
- The intervention aimed to eliminate the translesional pressure gradient and re-establish visceral and renal artery perfusion.
- A systematic review of published IVL cases in visceral and paravisceral disease was conducted.
Main Results:
- The described case demonstrated successful restoration of visceral and renal perfusion with abolition of the translesional gradient.
- One-year follow-up confirmed durable arterial patency and complete resolution of CMI symptoms.
- Literature review indicated high technical success, symptomatic improvement, and acceptable short-term safety for IVL in visceral interventions.
Conclusions:
- Intravascular lithotripsy is an effective endovascular treatment for extensive paravisceral atherosclerosis leading to CMI.
- This case and literature review contribute to the growing evidence supporting IVL's role in complex mesenteric and paravisceral interventions.
- Further research is needed to establish the long-term durability of IVL in these challenging vascular conditions.
Abstract:
Chronic mesenteric ischemia (CMI) secondary to extensive paravisceral atherosclerosis is a rare but challenging vascular condition, often presenting with postprandial abdominal pain, weight loss, and claudication due to impaired blood flow. While surgical bypass is a standard treatment, it carries significant risks, particularly in patients with severe calcified vascular disease. Advances in endovascular techniques, including intravascular lithotripsy, offer less invasive alternatives for select cases. We describe the application of IVL in a patient with near-total paravisceral aortic occlusion involving the origins of the superior mesenteric, celiac, and bilateral renal arteries. A multidisciplinary endovascular-first approach integrated IVL, angioplasty, and embolic protection, abolishing the translesional gradient and restoring visceral and renal perfusion. One-year follow-up confirmed durable patency and symptom resolution. To contextualize this case, we reviewed published reports of IVL in visceral and paravisceral disease, which collectively demonstrate high technical success, symptomatic improvement, and acceptable short-term safety, though long-term durability data remain limited. This case illustrates the effective use of endovascular lithotripsy for extensive paravisceral atherosclerosis causing CMI. This paper adds to emerging evidence supporting the role of IVL in complex mesenteric and paravisceral interventions.
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