Shockwave Javelin Peripheral For The Treatment Of A Long Anterior Tibial Artery Occlusive Lesion

This case, courtesy of Dr. Maria Antonella Ruffino, Interventional Radiology, Lugano, features an 83-year-old male patient with type 2 diabetes, dyslipidemia, and hypertension. He is suffering from Rutherford class 5 peripheral artery disease (PAD) and is presenting a heel ulcer.

Pre-procedure

Baseline angio shows a total occlusion of the anterior tibial artery (ATA), with a diffuse lesion of 30 cm length. Ankle-brachial index (ABI) pre procedure: 0.30.
Pre-procedure

Image shows poor distal run-off at the dorsalis pedis artery.
Shockwave Javelin Treatment

After crossing with a 0.014 guidewire, 2.0 mm percutaneous transluminal angioplasty (PTA) balloon couldn’t cross at the origin of the ATA. Shockwave Javelin Peripheral was used to modify the calcium and cross the occlusion.
Shockwave Javelin Treatment

120 pulses were delivered along the proximal and medial segment of the ATA. Shockwave Javelin Peripheral allowed to modify calcium along the lesion, enabling effective treatment with 2.5 mm PTA balloon.
Post-procedure

Final angio shows restored flow of the anterior tibial artery. ABI post procedure: 0.75.
Post-procedure

Foot angio shows direct flow from the anterior tibial artery into the dorsalis pedis and increased perfusion to the heel.