Intravascular Lithotripsy For Severe Peripheral Artery Calcification - A 3-Year Single Centre Experience
Inês Gueifão1, Ricardo Correia1, Anita Quintas1
1Hospital de Santa Marta, Unidade Local de Saúde de São José, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal.
Insights
Intravascular lithotripsy (IVL) effectively prepares severely calcified arteries for endovascular procedures in peripheral artery disease (PAD). This adjunctive treatment demonstrated safety and efficacy, with low complication rates in femoropopliteal interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Severe arterial calcification poses significant challenges in endovascular procedures, impacting success rates and patient outcomes.
- Conventional balloon angioplasty often yields insufficient luminal gain, necessitating advanced plaque modification techniques.
- Intravascular lithotripsy (IVL) has emerged as a promising adjunctive strategy for treating complex arterial lesions.
Purpose of the Study:
- To evaluate the institutional experience and outcomes of using intravascular lithotripsy (IVL) for peripheral artery disease (PAD) treatment.
- To assess the safety and efficacy of IVL as a vessel preparation tool in endovascular revascularization.
- To analyze procedural success, complications, and clinical outcomes in patients undergoing IVL for PAD.
Main Methods:
- Retrospective analysis of a prospectively maintained database from October 2021 to September 2024.
- Inclusion of patients who underwent IVL for vessel preparation during endovascular treatment of PAD.
- Data collection included patient demographics, risk factors, lesion characteristics, procedural details, and clinical outcomes.
Main Results:
- Nineteen patients (79% male, median age 76) with PAD were treated, primarily with femoropopliteal lesions (68%).
- IVL facilitated lesion crossing and was predominantly followed by stenting (79%), with no procedural complications reported.
- Major adverse limb events (MALE) were low (5% major amputation), and all-cause mortality was 16%.
Conclusions:
- Intravascular lithotripsy (IVL) is a safe and effective adjunctive therapy for vessel preparation in endovascular revascularization, particularly for femoropopliteal lesions.
- The procedure demonstrated infrequent complications, MALE, and mortality.
- Further research is warranted for aortoiliac and infrapopliteal applications and comparative studies with alternative treatments.
Introduction:
Severe arterial calcification is a challenging limitation in endovascular procedures leading to worse success rates and outcomes. Conventional balloon angioplasty may provide limited luminal gain, calling for adjunctive strategies of plaque modification, such as intravascular lithotripsy (IVL). The aim of this study is to describe our institutional experience with IVL in the treatment of peripheral artery disease (PAD).
Materials And Methods:
A prospectively maintained database from a tertiary academic medical centre was retrospectively enquired from October 2021 to September 2024. The study included all patients who underwent IVL (Shockwave Medical, Inc., California, USA) for vessel preparation during endovascular treatment of PAD.
Results:
19 patients were included (79% male, median age 76 years) with a median follow-up period of 6 and total of 35 months. Most common risk factors were hypertension (90%), diabetes (68%), dislipidemia (63%) and ischaemic heart disease (63%). Clinical presentation was mostly chronic limb-threatening ischemia (Fontaine grade IV in 74% and Fontaine grade III in 10%). The target lesion undergoing IVL was most often femoropopliteal (68%). Intraprocedural lesion crossing was almost equally subintimal and intraluminal (53% vs. 47%) and definitive treatment was mostly performed with stenting (79%). Additionally, 3 patients (16%) underwent a hybrid procedure with femoral endarterectomy (11%) or femoro-femoral bypass (5%). There were no identified procedural complications. Major adverse limb events (MALE) included no reinterventions and 1 major amputation (5%), and the all-cause mortality rate was 16%. Regarding the 14 patients in Fontaine grade IV, the wound healing rate was 57%.
Discussion/Conclusion:
IVL is a safe and effective adjunctive in vessel preparation during endovascular revascularisation procedures, particularly in the femoropopliteal sector. Procedure and/or device-related complications, MALE and mortality are infrequent. Further research is needed concerning aortoiliac and infrapopliteal sectors and comparison with other supplementary treatment alternatives.
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