A male patient presents with short-distance, lifestyle-limiting claudication of the left lower extremity (LLE) and having failed an exercise program.

Using a contralateral approach to access the the LLE, Dr. Foteh successfully crosses the lesion and advances the Shockwave E8 6.0 mm x 80 mm catheter delivering all 400 pulses. Dr. Foteh deploys a series of stents and post-dilates with a PTA balloon, resulting in a widely patent superficial femoral artery with distal reconstitution of the popliteal artery. The case exhibits no dissections or embolic complications.

Dr. Foteh is a paid consultant of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Foley presents an 84 year-old male with history of heart failure, hypertension, diabetes, high cholesterol, non compressible ankle-brachial index (ABI), toe-brachial index (TBI) 0.3, limb threatening ischemia with a left hallux ulcer.

From an antegrade approach, Dr. Foley delivers 40 pulses from Shockwave Javelin to modify the focal peroneal lesion and enable crossing. This was followed by a 3.5mm x 40 mm PTA balloon, resulting in an impressive gain with IVL therapy with no dissections or embolic complications.

Dr. Foley is a paid consultant of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Foley presents an 88 year-old female with a history of chronic venous insufficiency, end stage chronic obstructive pulmonary disease (COPD), lymphedema, peripheral artery disease (PAD), with abnormal ankle-brachial index (ABI), abnormal toe-brachial index (TBI), and a non-healing superficial lower extremity wound.

After successful crossing of the lesion, Dr. Foley uses a 6.0 mm x 80 mm Shockwave E8, followed by intravascular ultrasound (IVUS) to confirm angiographic results, and completes a post dilation with a 6.0 mm x 60 mm drug coated balloon (DCB) angioplasty improving flow and allowing time for wound healing with no dissection or embolic complications.

Dr. Foley is a paid consultant of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

This recorded webinar features an in‑depth, case‑based discussion focused on the treatment of heavily calcified below‑the‑knee (BTK) disease in patients with peripheral artery disease (PAD) and chronic limb‑threatening ischemia (CLTI). The session is moderated by Misty Humphries, MD, MAS, vascular surgeon at UC Davis Medical Center in Sacramento, CA, and includes expert faculty Venita Chandra, MD of Stanford University (Stanford, CA) and Leigh Ann O’Banion, MD of UCSF Fresno (Fresno, CA).

Dr. Humphries opens the webinar with an overview of the paradigm shift in BTK calcium management, highlighting the clinical challenges posed by diffuse, medial calcification, vessel recoil, and small vessel diameter in CLTI patients. She reviews best practices for intravascular lithotripsy (IVL), emphasizing the importance of intravascular ultrasound (IVUS)‑guided sizing, appropriate balloon oversizing relative to reference vessel diameter, and low‑pressure inflation to optimize calcium fracture and luminal gain while maintaining a strong safety profile. Technical features and use cases for Shockwave E8 and the Javelin forward‑emitting IVL catheter are also discussed.

Dr. Chandra reviews outcomes from the FORWARD study and new 12‑month data from the DISRUPT BTK II trial. She highlights the real‑world nature of these studies, which include patients with severe calcification, chronic total occlusions, diabetes, and end‑stage renal disease. Key findings discussed include low angiographic complication rates, meaningful reductions in diameter stenosis, favorable patency and freedom‑from‑TLR outcomes, high freedom from major amputation, and improvements in Rutherford classification, wound healing, and quality‑of‑life metrics.

Dr. O’Banion concludes the program by presenting real‑world cases that illustrate access planning, lesion crossing strategies, and treatment of diffuse tibial and pedal disease. Her cases demonstrate practical use of IVL technologies to modify calcified vessels, restore inline flow to wound‑related angiosomes, and achieve limb salvage without the need for stenting or surgical bypass in selected patients.

Throughout the discussion, the faculty emphasize multidisciplinary limb‑salvage decision‑making, thoughtful device selection, and the evolving role of IVL in treating complex BTK disease.

Learn more about DISRUPT BTK II here.

Drs. Humphries, Chandra, and O’Banion are paid consultants for Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Foteh shares an IVL procedure on an 85 year-old female with history of coronary artery disease (CAD), hypertension, hyperlipidemia, diabetes, who presented with a calcaneal ulcer and abnormal ankle-brachial and toe-brachial indices.

After successfully crossing the lesion, Dr. Foteh advances a Shockwave IVL E8 5.0 mm x 80 mm catheter delivering all pulses. IVL therapy is followed by a 5.0 mm x 40 mm drug coated balloon (DCB) resulting in improved flow with no dissection or embolic complications.

Dr. Foteh is a paid consultant of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Foteh presents a 79 year-old male patient with history of coronary artery disease (CAD), hypertension, hyperlipidemia, peripheral artery disease (PAD), and abnormal ankle-brachial (ABI) and toe-brachial indices (TBI).

Using a contralateral approach, Dr. Foteh successfully crosses the lesion advancing a 4.0 mm x 80 mm Shockwave IVL E8, followed by a 4.0 mm drug coated balloon (DCB) in the anterior tibial and a larger DCB in the superficial femoral artery (SFA), providing improved flow with no dissection or embolic complications.

Dr. Foteh is a paid consultant of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.

Dr. Foley presents an 88 year-old male with a history of heart failure, and non-compressible ankle-brachial index (ABI), and very reduced toe-brachial index (TBI), with a gangrenous ulcer of the right hallux.

Using an antegrade right common femoral approach, Dr. Foley successfully crosses the lesion and advances the Shockwave IVL Javelin, followed by post dilation with a 3.0 mm x 22 mm PTA balloon resulting in improved distal flow with no dissection or embolic complications.

Dr. Foley is a paid consultant of Shockwave Medical.

Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.