Pre-EVAR

Calcified Iliac Treatment Prior to AAA Graft Delivery

Prior to the placement of a stent graft this patient was found to have a 4-6cm, 80-90% calcific stenosis in both iliac arteries making the physician unable to place a AAA graft. An 8.0mm Shockwave M⁵⁺ was used in both iliacs to modify the calcium and change vessel compliance. After IVL therapy a 20Fr. AAA graft was able to be safely delivered.

Diagnostic Angiogram

Iliac reference vessel diameter > 8mm 80-90% stenosed lesion length 4-6cm circumferential calcium

IVL Therapy

8 x 60mm Shockwave M⁵⁺ 150 pulses to both sides

AAA Graft Delivered

20 Fr. AAA graft safely delivered

Final Angiogram

>20% residual stenosis, no dissections, no embolization

Case courtesy of Dr. Bobby Mendes

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

CME: Utilizing Intravascular Lithotripsy for Large-Bore Access in EVAR and TEVAR Procedures

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

Identify current best practices for large-bore access in endovascular repair of aortic aneurysm (EVAR) and thoracic endovascular repair of aorta (TEVAR) procedures
Understand the data surrounding lithotripsy for large-bore access
Safely obtain large-bore access during endovascular aortic repairs