229 - Preliminary Experience with Intravascular Lithotripsy for Critical Limb-threatening Ischemia of the Upper Extremities

Purpose: To evaluate whether intravascular lithotripsy (IVL) extends the patency of upper extremity arterial occlusive disease beyond that of plain balloon angioplasty (POBA).

Materials and Methods: This retrospective case series included all patients undergoing IVL for critical limb-threatening ischemia of the upper extremities at a single institution, from September 2022 to August 2025. Frequencies are reported, and Kaplan-Meier survival analysis was performed to evaluate patency intervals of the target vessel, comparing POBA-to-IVL and IVL-to-reintervention or last follow-up, using each patient as their internal control.

Results: Eight patients (5 M, 3 F) with a mean age at treatment of 57 years (range: 47-71 years) were included. Comorbidities included end stage renal disease (N=6), diabetes mellitus (N=5), and smoking history (N=5). Nine upper extremities were treated (5 R, 4 L), with 7 presenting with tissue loss/ulceration and 2 with rest pain. Baseline Rutherford scores were 4 (N=2), 5, (N=3), or 6 (N=4). The target artery for IVL was radial (N=5), ulnar (N=2), or brachial (N=1), and 1 patient underwent IVL of both the brachial and radial arteries. Eight patients had undergone prior POBA at the target artery, with a mean time from POBA to IVL of 102 days (range: 4-248). Technical success of IVL, defined as lesion crossing with < 30% residual stenosis of target lesion post-IVL, was achieved in 8 of the 9 limbs (89%) with no immediate adverse events. Reintervention post-IVL with POBA was performed in 6 limbs (67%) due to loss of primary patency and/or recurrent symptoms, with mean time from IVL to POBA reintervention of 107 days (range: 4-209). Kaplan-Meier analysis estimated a median patency of 2.5 months post-POBA and 7 months post-IVL (P=0.17).

Conclusion: Initial experience with IVL for critical limb-threatening ischemia in the upper extremities showed high technical success; however, two-thirds underwent POBA reintervention. Target vessel patency interval post-IVL was longer than POBA but did not reach statistical significance.