Change Compliance to Change the Game

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.