Intravascular Lithotripsy for Peripheral Arterial Disease: Outcomes From a Single-Center Experience

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Medical Devices

Background:

• Intravascular lithotripsy (IVL) is increasingly utilized for severe lower-limb arterial calcification.
• A UK vascular center audit assessed IVL's safety and effectiveness in a real-world setting.

Purpose of the Study:

• To evaluate the safety and effectiveness of IVL in treating heavily calcified lower-limb arteries.
• To identify predictors of adverse outcomes in patients undergoing IVL.

Main Methods:

• Prospective audit of 45 consecutive patients undergoing IVL between March 2023 and September 2025.
• Data collected included demographics, lesion characteristics (PACSS grade), procedural details, and outcomes (30-day survival, amputation-free survival, complications, readmission).
• Statistical analyses included Fisher's exact test, t-tests, and Kaplan-Meier survival analysis.

Main Results:

• Technical success was achieved in 91% of cases with infrequent immediate complications.
• 30-day amputation-free survival was 75.6%, and 30-day overall survival was 88.9%.
• Severe calcification (PACSS grades 4-5) did not correlate with major amputation or peri-procedural complications. Emergency admission and 30-day readmission were adverse prognostic markers.

Conclusions:

• IVL demonstrated high technical success and safety in a critical limb-threatening ischemia (CLTI) cohort with complex calcified disease.
• Outcomes are influenced by baseline disease severity and urgency of presentation.
• IVL is a viable vessel preparation strategy, warranting further large-scale studies for patient selection and long-term outcome assessment.