IVL opens calcified iliacs to enable passage of TAVR device

This patient was an 85-year-old woman with calcified iliacs and severe rest pain. This patient was not a surgical candidate due to lung disease. She had no transcaval or subclavian access option available. Shockwave M5 was delivered to both iliacs and IVL therapy was used, allowing the safe passage of a 26mm Metronic Evolut R TAVR device, followed by endovascular femoral repair. The patient was discharged the next day.


tvar pre procedure 1

Bilateral IVL

bilateral xray progression


pre tavr xray progression
Case courtesy of Dr. Brian Kolski

CME: Utilizing Intravascular Lithotripsy for Large Bore Access in TAVR and TAVI Procedures

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


  • Identify current best practices for large bore access in TAVR and TAVI procedures
  • Understand the data surrounding IVL for large bore access
  • Safely obtain large bore access during endovascular repairs
Dr Asma Khaliq headshot

Asma Khaliq, MD

Assistant Professor, Endovascular Director/Interventional Cardiologist | Montefiore Hospital, Bronx, New York
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Associate Program Director | Michigan State University, McLaren Macomb-Oakland, Mount Clemens, Michigan
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IVL-assisted TF TAVR Proved to be Safe and Effective

European Registry: IVL to Facilitate Transfemoral TAVR


To report on the safety and efficacy of IVL-assisted TF TAVR in an all-comers population

  • Prospective, real-world, multi-center registry
  • All patients treated by IVL-assisted TF TAVR ’18 - ’20
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High-volume European centers
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4.6 ± 0.9mm w/ 318° of calcium

Results: High Success, Low Complications

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IVL has helped to expand the indications for TF TAVR in patients with severe calcific PAD

Transfemoral TAVR (%)

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IVL-Assisted TAVR (%)

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Nardi & De Backer et al. Peripheral intravascular lithotripsy of iliofemoral arteries to facilitate transfemoral TAVI: a multicentre prospective registry. EuroIntervention 2021;17-online publish-ahead-of-print November 2021.


A Prospective Registry of Intravascular Lithotripsy-Enabled Vascular Access for Transfemoral Transcatheter Aortic Valve Replacement, Di Mario et al, JACC Interventions, March 2019.
Read More
intravascular lith pdf
Intravascular Lithotripsy-Assisted Transfemoral TAVI: The Copenhagen Experience and Literature Review, De Backer et al, Frontiers in Cardiovascular Medicine, September 2021.
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Peripheral intravascular lithotripsy pdf
Peripheral intravascular lithotripsy for transcatheter aortic valve implantation: a multicentre observational study, Nardi et al, Eurointervention, April 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

Shockwave M5+ IVL catheter
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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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C18047 L6H L6 Long Hi Res 221220 01

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