Object

Peripheral vascular disease (PVD) is a major cause of morbidity and mortality with increasing need for interventional therapies. Vascular calcification increases risk of complications and may impair the effect of antiproliferative therapy. Intravascular lithotripsy (IVL) using pulsatile sonic pressure waves to modify intimal and medial calcium is a promising approach for those patients to overcome the drawbacks of vascular calcification.

Methods

A retrospective record review of cases using IVL was performed for the period from december 2018 to october 2020 at our centre.

Results

59 cases of IVL were performed in 51 patients with Rutherford class 3. Mean age was 71 years with 78 % (40) of the patients being men. The majority (69 %) of cases was done with a retrograde approach.  IVL delivery was successful in all cases but o, in 41 % (n=24) a predilation was necessary. We treated 8 iliac, 16 common femoral, 49 superficial femoral, 5 deep femoral, 28 popliteal and 2 crural lesions with balloon sizes from 4.0 to 7.0 mm. In 34 cases IVL was used as a stand alone therapy, in the remaining 25 an adjunctive therapy (DCB and/or stent) was used. A ballon rupture  occured in 6 cases after 3 cyles. There were no complications. Mean ABI improved from 0.6 to 0.8 after the intervention and 1.0 during mid-term follow-up (Figure 1).

Conclusion

We report compelling safety and excellent short- and mid-term results using IVL in a complex, difficult to treat cohort. This innovative approach will gain more interest in future, especially since long term effects of paclitaxel eluting devices are controversially discussed.

Figure 1-Mean ABI before intervention, after lithotripsy and during follow-up visit