Calcified Iliac Treatment Prior to AAA Graft Delivery

A 78-year-old male patient presented to Dr. Bosiers of Insel Bern, Switzerland with acute abdominal pain. CT assessment confirmed the presence of a contained ruptured infrarenal aneurysm. The case was complicated by heavy calcification in bilateral common iliac arteries, with the left CIA measuring a lumen of 2.8mm - 4.2mm and the right CIA with a lumen of 4.8mm - 4mm.

 

Calcification was so inhibiting in the left CIA a 4f Pigtail failed to pass over an 035 wire. Dr. Bosiers proceeded to treat the bilateral Iliac calcification with an 8x60mm Shockwave M5+ IVL catheter. Firstly, he treated the right CIA using 150 pulses. Attention then switched to the left CIA, following a pre-dilation with a 3mm PTA. Dr. Bosiers delivered the remaining 150 pulses of M5+ to treat the left CIA.

 

This provided good luminal expansion and a change in vessel compliance to facilitate the implantation of a Medtronic endurant graft 28x16 to treat the ruptured triple AAA. The main body was delivered from a right access through an 18fr sheath while the contralateral limb was delivered through a 14fr sheath from the left.

 

The control CT on procedural completion showed complete exclusion of the aneurysm with significant bilateral luminal gain in the common iliac arteries with excellent limb expansion and the patient’s abdominal pain was resolved.

CHANGE COMPLIANCE TO CHANGE THE GAME WITH THIS EVAR AND TEVAR TUTORIAL SERIES

In this three-episode tutorial series, Dr. Stefano Fazzini and Dr. Michel Bosiers provide an excellent overview on how IVL removes the barriers of calcified hostile access and expands treatment boundaries in EVAR and TEVAR procedures by changing vessel compliance, facilitating luminal gain and significantly reducing complications.

CHAPTER 1:

Challenges of Hostile Calcified Access & Existing Treatment Strategies

CHAPTER 2:

Understanding IVL and Where It Fits Into Our Practice

CHAPTER 3:

IVL and Hostile Access in Practice

Choose the right endograft for your patient with Shockwave IVL

Interested in learning more? Read the online Vascular News supplement, “Change compliance to change the game in PAD treatment” to learn how IVL is evolving calcium management for hostile access in endograft delivery.

Allow safe EVAR in patients with severe calcification

Learn how Drs. Bosiers, Isernia and Fazzini utilize IVL to facilitate endograft delivery

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On The +Plus Side

See how the faster, further, larger Shockwave M5+ can help treat your patients with calcified PAD

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