Treating a Calcified Popliteal CTO With No Complications

This was a 72 year-old female patient presenting with lifestyle limiting claudication and more recently getting rest pain at night with symptoms being worse in the left leg. The patient is a former smoker, has diabetes and CKD. Invasive angiography of the left leg showed a chronic total occlusion in the P1 and P2 segments of the popliteal with no iliac disease and three vessel runoff to feet. The CTO was crossed and a 3.0mm POBA was used for the initial dilation. Then a 5.0mm Shockwave M5+ was used along the calcified segments, finishing with a DCB. IVUS imaging of calcified segments showed no dissections and good vessel expansion.

Pre-Treatment Angiogram

Pre Treatment Angiogram above tk
Diameter stenosis = 100%

Post Pre-Dilation

post above tk
3mm POBA


post ivl above tk
5 x 60mm Shockwave M5+

Final Angiogram

final angi above tk
No dissections, perforations, or stent Residual stenosis = 10%
Case courtesy of Dr. Anand Prasad

IVL Shows Consistent safety and effectiveness in DISRUPT PAD III Randomized Control Trial & DISRUPT PAD III Observational Study


group of people


group of people

1Tepe et al., J Am Coll Cardiol Intv 2021

2E. Armstrong, VIVA Late Breaking Clinical Trial 2022


IVL maintains control of the procedure by minimizing complications such as dissections, embolization, and perforations. IVL significantly reduces the need for bailout stents, preserving future treatment options.


IVL 77% reduced dissections bar graph


0% embolization, perforation, thrombus, and no flow


IVL 75% reduction in bailout stenting bar graph

1Tepe et al., J Am Coll Cardiol Intv 2021

Excellent Long-Term Results1

IVL has demonstrated excellent patency out to two years in a severely calcified patient population.

Primary Patency*

IVL primary patency percent over time line graph
*Primary Patency defined as freedom from provisional stenting at index procedure, freedom from clinically-driven target lesion revascularization, and freedom from restenosis determined by duplex ultrasound

1Tepe et al., J Am Coll Cardiol Intv 2021

CME: Tackling Calcium in the SFA/Popliteal: What’s in your toolbox?

After participating in this activity, learners should be better able to:


  • Identify calcium in the superficial femoral and popliteal artery
  • Develop an algorithm for treatment based on lesion type
  • Utilize intravascular lithotripsy and other available tools to treat calcium in the SFA/Pop
Dr Venita Chandra headshot

Dr. Venita Chandra

Stanford University Medical Center Stanford, CA
Dr Dan Clair headshot

Dr. Dan Clair

Vanderbilt University Medical Center Nashville, TN
Dr Constantino Pena headshot

Dr. Constantino Peña

Miami Cardiac & Vascular Institute Miami, FL
Dr Varshana Gurusamy headshot

Dr. Varshana Gurusamy

MUSC Charleston, SC
Attend CME


Intravascular Lithotripsy for Peripheral Artery Calcification
Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial, Tepe et al, July 2022.
Calcific Common Femoral Artery Disease
Endovascular Intravascular Lithotripsy in the Treatment of Calcific Common Femoral Artery Disease: A Case Series With an 18-Month Follow-Up, Baig et al, October 2022.
shockwave on the plus sign

On The +Plus Side

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

Shockwave M5+ IVL catheter
shockwave cracked blue white RGB L6


Introducing the New Shockwave L6 Peripheral IVL Catheter Available in 8.0, 9.0, 10.0 and 12.0mm diameter sizes

L6 1920x

Ready to Make Waves with Shockwave IVL?

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