Shockwave Javelin Below-the-Ankle Case Review with Dr. Michael Siah

In this video, Dr. Michael Siah from UT Southwestern in Dallas presents a complex limb-salvage case involving an 84-year-old patient with critical limb-threatening ischemia and peripheral arterial disease. The patient had significant comorbidities, including end-stage renal disease, heart failure, lupus, and a non-healing right foot ulcer, along with prior deep vein arterialization on the contralateral limb. Imaging revealed severe disease spanning the superficial femoral artery, tibial vessels, and below-the-ankle circulation, including a heavily calcified dorsalis pedis chronic total occlusion that proved difficult to treat with standard endovascular tools.

Dr. Siah walks through his strategy, detailing challenges with access, device delivery, and lesion crossing despite balloon angioplasty and intravascular lithotripsy (IVL). When conventional low-profile balloons and orbital atherectomy were unsuccessful due to delivery limitations, he turned to the Shockwave Javelin catheter where its use significantly modified the plaque and vessel compliance. This effect allowed a previously unsuccessful balloon to cross and treat the lesion, ultimately restoring inline flow to the forefoot.

The successful outcome—near-complete wound healing at six weeks and preservation of a functional transmetatarsal amputation—underscores the importance of patience, adaptability, and thoughtful tool selection when treating advanced limb ischemia.

Dr. Siah is a paid consultant of Shockwave Medical. Views expressed are those of the presenters and not necessarily those of Shockwave IVL.

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. Please contact your local Shockwave representative for specific country availability.