Abstract

We present a case of successful intravascular lithotripsy for the treatment of a heavily calcified peripheral artery disease lesion. A patient presented to the clinic with the chief complaint of intermittent right calf claudication occurring for two years. Non-invasive imaging confirmed extensive calcific lesions with critical stenoses predominantly in the superficial femoral artery. Intravascular lithotripsy was performed along the course of the lesions, followed by drug-coated balloon applications and angioplasty without stenting. Endovascular treatment of lower extremity peripheral arterial lesions is a rapidly evolving field, with much of the focus in recent years on the management of vascular calcification – a common and challenging problem that can increase the risk of procedural complications and compromise long-term outcomes. Existing methods for clearing calcium deposits have  so far not offered a risk-benefit ratio sufficient to justify their widespread adoption. Lithotripsy in this setting offers a novel and effective way to modulate calcium both in the intima and media layers of the vessel wall without requiring high dilatory pressures or causing vessel trauma. This may facilitate optimal vessel preparation by softening the lesion and improve the efficacy of subsequent drug-coated balloon angioplasty. Our patient remained asymptomatic during ambulation at a 6-month follow-up, demonstrating the potential benefits of this innovative technology for managing complex calcified lesions. In the context of this case, the patient has moved abroad and has not returned for subsequent follow-up, no information on their current status exists.