Arterial Interventions and Peripheral Arterial Disease (PAD)
Yasaswi Vengalasetti, M.S.
Stanford university School of Medicine
Disclosure(s): No financial relationships to disclose
Brian J. Schiro, MD
Vascular and Interventional Radiologist
Miami Cardiac & Vascular Institute / Radiology Associates of South Florida
Intermittent claudication is a common, early presenting symptom of peripheral artery disease (PAD) and can cause notably reduced mobility and quality of life. The goal of this study is to assess the effect of intravascular lithotripsy on the degree of vessel luminal stenosis (i.e., luminal gain), ankle-brachial index (ABI), and intraprocedural complications in the treatment of patients with PAD presenting with claudication.
Materials and Methods:
Patients within our institution who underwent intravascular lithotripsy in lower extremity calcified lesions from 2018-2022 were identified in the Philips’ IntelliSpace PACS Radiology database. Our study population was restricted to Claudication patients classified Rutherford 1-3. The following primary datapoints were obtained: pre- and post-treatment luminal stenosis, pre- and post-treatment resting ABI, lesion location, adjunctive therapies used within the target lesion, and intraprocedural complications. Overall, 22 target lesions were identified in 19 patients. Pre- and post-treatment ABI measurements were recorded in 14 treated limbs in 14 patients. Statistical analysis was performed using paired sample t-test.
Mean luminal gain in all target lesions treated with intravascular lithotripsy was 81.32%. Analysis of vessel subgroups demonstrated a luminal gain of 80.63% in the aortoiliac region (n=8), 76.67% in the common femoral artery, (n=3), and 83.09% in the femoropopliteal region (n=11). Luminal gain in lesions treated with IVL alone vs. IVL + any adjunctive therapy was 75.44% and 85.38, respectively. A mean improvement in ABI of 0.1964 (p=0.01) was observed across 14 treated limbs. Two cases of intraprocedural complications were noted in 19 patients (11%): one case of vessel wall dissection and one case of distal embolization.
Conclusion: Intravascular lithotripsy is both safe and efficacious in reducing vessel stenosis and improving ABI when treating patients experiencing claudication