Intravascular Lithotripsy for Calcified Femoral Artery Lesions in Patients with Peripheral Arterial Disease: An Early...

Severe calcification in femoral artery disease complicates endovascular treatment. Intravascular lithotripsy (IVL) uses acoustic pressure waves to modify calcium and may improve vessel preparation, but real-world data in femoral lesions are limited. To evaluate shockwave IVL safety, feasibility, and clinical outcomes for calcified femoral artery lesions in symptomatic peripheral arterial disease patients in a real-world setting, focusing on early experience and technical success.

We retrospectively reviewed all consecutive patients treated with shockwave IVL for calcified femoral artery lesions at our center from November 2016 to July 2024. We assessed technical success, complications, and freedom from target lesion revascularization (TLR).

We treated 49 patients (mean age 75 years, 71% male) with heavily calcified femoral disease. Most had claudication, but 29% presented with chronic limb-threatening ischemia. Technical success was achieved in 45/49 cases (91.8%). Residual stenosis averaged 22%, and only 12% required femoral stenting. Four patients (8.2%) had in-hospital complications, including one pseudoaneurysm requiring surgery. There was one death within 30 days (myocardial infarction) and no major amputations. Follow-up was heterogeneous (median 3 months). Rutherford class improved significantly (P < 0.001). Freedom from confirmed femoral TLR was 88% at 12 months and 75% at 24 months, though numbers at risk were small beyond 12 months and follow-up was heterogeneous.

In this high-risk cohort, IVL achieved 91.8% technical success with low early complications and avoided femoral stenting in 88% of cases. Freedom from femoral TLR was 88% at 12 months and 75% at 24 months, though follow-up was limited. These results support IVL as a feasible option for calcified femoral disease, but longer follow-up is needed.