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

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

EXCEPTIONAL SAFETY PROFILE

pad 3 safety profile table

PROVEN EFFECTIVE CALCIUM MODIFICATION

pad 3 effective graph

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

2E. Armstrong, VIVA Late Breaking Clinical Trial 2022

PRESERVED OPTIONS1

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.

REDUCED DISSECTIONS

pad 3 chart 2 a

LOW COMPLICATIONS

pad 3 chart 2 b

REDUCED BAILOUT STENTING

pad 3 chart 2 c

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*

primary patency

*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
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SPONSORED PODCASTS

vi 172 above the knee calcium thumbnail
CLI fighters Dr. Bryan Fisher and Dr. Sabeen Dhand discuss their approach to treating calcified arteries above the knee, including looking at newer technologies and choosing the appropriate device to effect real durable change to the calcified wall.
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vi 181 cfa disease surgical vs endovascular thumbnail
Vascular Surgeon Dr. Mazin Foteh and our host Dr. Sabeen Dhand consider various factors that can influence the choice of treatment methods for calcified common femoral artery (CFA) disease, including discussing the pros and cons of an endovascular vs surgical approach.
Listen Now
vi 310 intravascular lithotripsy for fem pop disease in the asc thumbnail
In this episode, host Dr. Aaron Fritts interviews Dr. Jim Melton and Amanda Stanley about intravascular lithotripsy in the ASC, including reimbursement trends, patient selection and the future of the device.
Listen Now

PUBLICATIONS

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.
READ MORE
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.
READ MORE
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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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Shockwave M5+ IVL catheter
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BE LARGE & IN CHARGE

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

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