Case submitted by Roger Gammon, MD, Heart Hospital of Austin

Summary: Extensive trifurcation calcification involving anterior tibial and tibioperoneal trunk. Multiple previous failed interventions. Prior to Shockwave IVL, multiple failed percutaneous transluminal angioplasty (PTA) and cutting balloons used in the same procedure. 4.0 mm x 60 mm Shockwave IVL delivered across PT ostium and three cycles delivered. Same catheter moved to AT ostium and three cycles delivered. Final result shows resolution of stenosis and good flow.