Use of Intravascular Lithotripsy for Severe Calcification in Endovascular Aortoiliac and Common Femoral Arterial Reconstruction
Sankrit R. Kapoor1*; Rohan Virdee, BMBS2*; Michael Leshen, MD3; Devang Butani, MD3; Sanjiv Virdee, MD3
J CRIT LIMB ISCHEM 2023;3(1):E37-E38. Epub 2023 February 3. doi: 10.25270/jcli/CLIG23-00005
A 62-year-old female with severe lifestyle-limiting claudication and rest pain presented in clinic based on preoperative evaluation with significant inflow disease. Periprocedural brachial aortogram demonstrated extensive abdominal aortoiliac occlusive disease (Figure 1 and Figure 2). The iliac occlusions bilaterally included the common iliac artery (CIA) and left external iliac artery (EIA). Hypertrophied iliolumbar and inferior mesenteric vessels provided collateral circulation. Calcified plaque in the right common femoral artery (CFA) resulted in 85% stenosis.
Using brachial access, right CIA and aortic occlusive disease were successfully recanalized. A wire was passed through the right CFA stenosis. Due to the calcified lesion in the right CFA, Shockwave intravascular lithotripsy (Shockwave Medical) was used in preparation for right groin retrograde access via the profunda femoris artery (Figure 3). The distal aorta, left CIA, and EIA occlusive disease were successfully recanalized.
Kissing Shockwave balloons were used for heavy calcifications in the distal aorta and CIA (Figure 4). Following stenting of the distal aorta and CIA, covered balloon-mounted stents were employed. The left EIA was treated with a self-expanding covered stent.
Postprocedural angiography and intravascular ultrasound demonstrated no residual stenosis with collateral flow reduction. Same-day and up to 10-month follow-up exams noted overall improvement and no symptom reoccurrence (Figure 5).
Angioplasty with kissing stents does not always result in the best patency rate in patients with Trans-Atlantic Inter-Society Consensus (TASC) D lesions, such as those demonstrating severe calcific disease. In the patient described herein, kissing-stent primary patency rate was improved via intravascular lithotripsy prior to stenting in the highly calcified abdominal aortoiliac occlusions. This form of occlusive disease was not previously treated endovascularly due to severe stenosis in the CFA. Intravascular lithotripsy can be useful in modifying normally resistant, calcified plaque morphology to allow endovascular treatment of occlusive disease in the CFA.
Affiliations and Disclosures
*Joint first authors.
From the 1University of Rochester, Rochester, New York; 2University Hospital Coventry and Warwickshire; and 3Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Accepted for presentation at the 2022 International Symposium on Endovascular Therapy (ISET) and the Virtual Angio Club at the West Coast Vascular and Interventional Symposium.
The authors report that patient consent was provided for publication of the images used herein.
Manuscript accepted January 25, 2023.
Address for correspondence: Sankrit R. Kapoor, MD, University of Rochester, Joseph C. Wilson Boulevard CMC, Box 275766, Rochester, NY 14627. Email: email@example.com