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Intravascular iliac artery lithotripsy to enable transfemoral thoracic endovascular aortic repair

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@article{d501c4c46ad64b2cae892092555bbc0d,
title = "Intravascular iliac artery lithotripsy to enable transfemoral thoracic endovascular aortic repair",
abstract = "Thoracic endovascular aortic repair (TEVAR) is performed with large-bore delivery systems. Small-size access vessels may be a contraindication for TEVAR, particularly in case of severe calcifications. In this case report, we describe the first-in-man use of intravascular lithotripsy to enable transfemoral delivery of TEVAR stent grafts in a patient with severely calcified iliac arteries. A 69-year-old female with multiple sclerosis and thoracic aortic aneurysm (TAA) was referred for percutaneous TEVAR. Both common iliac arteries were severely calcified with circumferential calcifications and a minimum diameter below 5.5 mm. In order to enable percutaneous delivery of 20 French Valiant Navion stent grafts (Medtronic), the circumferential calcified plaques were treated by use of a Shockwave™ Peripheral Intravascular Lithotripsy Balloon (Shockwave Medical Inc.). Subsequently, the aortic stent grafts were safely and successfully passed through the iliofemoral artery and the TAA was excluded by TEVAR. Final angiography showed normal flow in the iliofemoral artery without any signs of perforation or overt dissection. This case report demonstrates successful application of intravascular lithotripsy in calcified iliofemoral arteries enabling percutaneous transfemoral TEVAR. If confirmed in future cases and trials, indications for transfemoral TEVAR may further expand toward patients with severely calcified peripheral arterial disease.",
keywords = "aortic disease, aortic repair, aorto-iliac disease, atherosclerosis, endovascular, new devices (in general)",
author = "Liesbeth Rosseel and {De Backer}, Ole and Lars S{\o}ndergaard and Gintautas Bieliauskas",
note = "{\circledC} 2019 Wiley Periodicals, Inc.",
year = "2020",
month = "2",
day = "15",
doi = "10.1002/ccd.28379",
language = "English",
volume = "95",
pages = "E96--E99",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "John/Wiley & Sons, Inc. John/Wiley & Sons Ltd",
number = "3",

}

RIS

TY - JOUR

T1 - Intravascular iliac artery lithotripsy to enable transfemoral thoracic endovascular aortic repair

AU - Rosseel, Liesbeth

AU - De Backer, Ole

AU - Søndergaard, Lars

AU - Bieliauskas, Gintautas

N1 - © 2019 Wiley Periodicals, Inc.

PY - 2020/2/15

Y1 - 2020/2/15

N2 - Thoracic endovascular aortic repair (TEVAR) is performed with large-bore delivery systems. Small-size access vessels may be a contraindication for TEVAR, particularly in case of severe calcifications. In this case report, we describe the first-in-man use of intravascular lithotripsy to enable transfemoral delivery of TEVAR stent grafts in a patient with severely calcified iliac arteries. A 69-year-old female with multiple sclerosis and thoracic aortic aneurysm (TAA) was referred for percutaneous TEVAR. Both common iliac arteries were severely calcified with circumferential calcifications and a minimum diameter below 5.5 mm. In order to enable percutaneous delivery of 20 French Valiant Navion stent grafts (Medtronic), the circumferential calcified plaques were treated by use of a Shockwave™ Peripheral Intravascular Lithotripsy Balloon (Shockwave Medical Inc.). Subsequently, the aortic stent grafts were safely and successfully passed through the iliofemoral artery and the TAA was excluded by TEVAR. Final angiography showed normal flow in the iliofemoral artery without any signs of perforation or overt dissection. This case report demonstrates successful application of intravascular lithotripsy in calcified iliofemoral arteries enabling percutaneous transfemoral TEVAR. If confirmed in future cases and trials, indications for transfemoral TEVAR may further expand toward patients with severely calcified peripheral arterial disease.

AB - Thoracic endovascular aortic repair (TEVAR) is performed with large-bore delivery systems. Small-size access vessels may be a contraindication for TEVAR, particularly in case of severe calcifications. In this case report, we describe the first-in-man use of intravascular lithotripsy to enable transfemoral delivery of TEVAR stent grafts in a patient with severely calcified iliac arteries. A 69-year-old female with multiple sclerosis and thoracic aortic aneurysm (TAA) was referred for percutaneous TEVAR. Both common iliac arteries were severely calcified with circumferential calcifications and a minimum diameter below 5.5 mm. In order to enable percutaneous delivery of 20 French Valiant Navion stent grafts (Medtronic), the circumferential calcified plaques were treated by use of a Shockwave™ Peripheral Intravascular Lithotripsy Balloon (Shockwave Medical Inc.). Subsequently, the aortic stent grafts were safely and successfully passed through the iliofemoral artery and the TAA was excluded by TEVAR. Final angiography showed normal flow in the iliofemoral artery without any signs of perforation or overt dissection. This case report demonstrates successful application of intravascular lithotripsy in calcified iliofemoral arteries enabling percutaneous transfemoral TEVAR. If confirmed in future cases and trials, indications for transfemoral TEVAR may further expand toward patients with severely calcified peripheral arterial disease.

KW - aortic disease

KW - aortic repair

KW - aorto-iliac disease

KW - atherosclerosis

KW - endovascular

KW - new devices (in general)

U2 - 10.1002/ccd.28379

DO - 10.1002/ccd.28379

M3 - Journal article

VL - 95

SP - E96-E99

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

IS - 3

ER -

ID: 59142914