Case Reviews

Shockwave Javelin for below the ankle revascularization In a patient with CLTI

This case, courtesy of Dr. Ashish Patel from St Thomas’, London, features a 71-year-old female patient, a smoker with hypertension Rutherford category 5 peripheral artery disease (PAD). The patient presents left hallux gangrene and severe rest pain and had no previous treatments. ​

  • Pre-procedure
    Baseline angio shows occluded lateral plantar and dorsalis pedis arteries. ​Ankle-brachial index (ABI) pre-procedure: 0.4.
  • DCB Treatment
    Superficial femoral artery (SFA) and popliteal artery presenting some fibrotic plaque were treated with 5.0 mm plain old balloon angioplasty (POBA) and drug-coated balloon (DCB) to improve flow.
  • Shockwave Javelin Treatment
    The lesion was wire crossable but not device crossable (IVUS did not cross).​ Shockwave Javelin Peripheral was able to advance through the lesion.
  • Shockwave Javelin Treatment
    Shockwave Javelin Peripheral was advanced via the posterior tibial artery and through the common plantar artery.
  • Shockwave Javelin Treatment
    120 pulses of Shockwave Javelin Peripheral delivered across the occluded lateral plantar and dorsalis pedis arteries.
  • Final Treatment
    After final treatment with 2.0 mm PTA balloon, final angio shows reconstitution of flow around the foot arch.​ ABI post-procedure: 0.8.

Case courtesy of Dr. Ashish Patel, St Thomas’, London.​

Dr. Ashish Patel is a paid consultant of Shockwave Medical.

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