{"id":14631,"date":"2026-07-15T12:23:29","date_gmt":"2026-07-15T17:23:29","guid":{"rendered":"https:\/\/shockwavemedical.com\/education\/shockwave-javelin-peripheral-ivl-distal-tibial-bta-case-reviews\/"},"modified":"2026-07-15T12:24:37","modified_gmt":"2026-07-15T17:24:37","slug":"shockwave-javelin-peripheral-ivl-distal-tibial-bta-case-reviews","status":"publish","type":"post","link":"https:\/\/shockwavemedical.com\/en-eu\/education\/shockwave-javelin-peripheral-ivl-distal-tibial-bta-case-reviews\/","title":{"rendered":"Shockwave Javelin Peripheral IVL Distal Tibial &amp; Below-The-Ankle Case Reviews"},"content":{"rendered":"\n<section id=\"block_c81b0830e92f0d18ae01b6064aff5273\" class=\"block block--wysiwyg wysiwyg_styles u-bgColorNone shockwave container\">\n\t<div class=\"u-wysiwyg u-animation\">\n\t\t<p>At SIR 2026, Dr. Narayanan Thulasidasan, Consultant Interventional Radiologist at Guy\u2019s and St Thomas\u2019 NHS Foundation Trust in London, UK, shares four challenging distal tibial and below-the-ankle (BTA) revascularization cases. These case reviews highlight treatment strategies for heavily calcified disease, procedural decision-making, and the use of <a href=\"https:\/\/www.shockwavemedical.com\/en-eu\/products\/shockwave-javelin-peripheral\/\">Shockwave Javelin<\/a> Peripheral Intravascular Lithotripsy (IVL) to facilitate successful limb salvage interventions.<\/p>\n<h3 id=\"case-1\">Case 1: Distal Tibial & Below-the-Ankle Revascularization Using Shockwave Javelin Peripheral IVL<\/h3>\n<p>Dr. Narayanan Thulasidasan presents the treatment of a complex below-the-ankle (BTA) chronic limb-threatening ischemia (CLTI) case in an 86-year-old patient with toe necrosis. Faced with heavily calcified distal pedal disease and limited treatment options, the team used Shockwave Javelin Peripheral IVL to facilitate lesion crossing and vessel preparation, followed by IVL and angioplasty. The case highlights decision-making in challenging distal tibial and pedal interventions and demonstrates successful restoration of blood flow to support wound healing.<\/p>\n<div class=\"video\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/q6Ur8TmspEU?si=V7brTTgybasPABb8\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<h3 id=\"case-2\">Case 2: Complex Pedal Arch Revascularization in a High-Risk CLTI Patient<\/h3>\n<p>In this video, Dr. Thulasidasan discusses a challenging below-the-ankle intervention in a patient with diabetes, end-stage renal disease, and tissue loss in a remaining limb. With severe calcification limiting device delivery, Shockwave Javelin Peripheral IVL was used to facilitate crossing and treatment of the dorsalis pedis, pedal arch, and posterior tibial artery. The case highlights procedural strategies for navigating complex pedal anatomy, optimizing lesion preparation, and restoring inline flow to support wound healing and limb preservation.<\/p>\n<div class=\"video\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/B73eATPNhy0?si=peMY58ElXZ1T-NjG\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<h3 id=\"case-3\">Case 3: Treating Severe Below-the-Ankle Calcification with Shockwave Javelin Peripheral IVL<\/h3>\n<p>Dr. Thulasidasan presents a case involving an 86-year-old patient with a non-healing hallux ulcer caused by a nail bed injury. Faced with extensive calcification and difficult catheter delivery below the ankle, the team used Shockwave Javelin Peripheral IVL to modify calcium in the posterior tibial artery and plantar circulation after conventional crossing techniques proved insufficient. The case highlights procedural decision-making, lesion preparation strategies, and the role of Shockwave Javelin Peripheral IVL in facilitating treatment of heavily calcified distal tibial and pedal vessels to improve perfusion and support wound healing.<\/p>\n<div class=\"video\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/9paZL7-8HGQ?si=ZjBGrxprHAH0IR_Q\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<h3 id=\"case-4\">Case 4: Urgent Limb Salvage Following Partial Foot Amputation<\/h3>\n<p>Dr. Thulasidasan presents a complex Rutherford 5 chronic limb-threatening ischemia (CLTI) case in a patient who required emergency partial foot amputation due to infection and sepsis. With severe below-the-ankle calcification limiting conventional treatment options, Shockwave Javelin Peripheral IVL was used to modify calcium in the posterior tibial and plantar arteries, enabling successful balloon delivery and revascularization. The case highlights the role of Shockwave Javelin Peripheral IVL in overcoming heavily calcified distal disease, restoring blood flow after urgent surgical intervention, and supporting ongoing wound healing.<\/p>\n<div class=\"video\"><iframe title=\"YouTube video player\" src=\"https:\/\/www.youtube.com\/embed\/smetsc1sZyQ?si=NjXH22OeH3qj_RnW\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<hr \/>\n<p><span class=\"legal_copy\">Dr. Thulasidasan is a paid consultant of Shockwave Medical. <\/span><\/p>\n<p><span class=\"legal_copy\"><strong>Shockwave IVL:<\/strong> In the U.S.: Rx only. Prior to use, please reference the <a href=\"https:\/\/shockwavemedical.com\/isi\/\">Important Safety Information<\/a> for more information on indications, contraindications, warnings, precautions and adverse events.<\/span><\/p>\n\t<\/div>\n\t\t\t<div class=\"button-container\">\n\t\t\t\n<a data-atom=\"button\" class=\"optional-button btn--primary\" href=\"https:\/\/shockwavemedical.com\/en-eu\/products\/shockwave-javelin-peripheral\/\" target=\"_self\" aria-label=\"Shockwave Javelin Peripheral IVL - link to page\" >Shockwave Javelin Peripheral IVL<i aria-hidden=\"true\" class=\"fa-sharp fa-arrow-right fa-solid\"><\/i><\/a>\t\t<\/div>\n\t<\/section>","protected":false},"excerpt":{"rendered":"<p>At SIR 2026, Dr. Thulasidasan shares four challenging distal tibial and BTA revascularization cases using Shockwave Javelin Peripheral IVL<\/p>\n","protected":false},"author":19,"featured_media":14582,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":[402,204],"meta":{"_acf_changed":false,"content-type":"","footnotes":""},"categories":[17],"tags":[],"disease-state":[167],"education-topic":[187],"product-tag":[420],"specialty":[332,336,344],"technology":[324],"class_list":["post-14631","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-en-uk","disease-state-peripheral-artery-disease-en-uk","education-topic-case-reviews-en-uk","format-case-en-uk","format-video-en-uk","product-tag-shockwave-javelin-peripheral-ivl-catheter-en-uk","specialty-interventional-radiologists-en-uk","specialty-nurses-technologists-en-uk","specialty-vascular-surgeons-en-uk","technology-peripheral-ivl-en-uk"],"acf":[],"_links":{"self":[{"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/posts\/14631","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/users\/19"}],"replies":[{"embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/comments?post=14631"}],"version-history":[{"count":1,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/posts\/14631\/revisions"}],"predecessor-version":[{"id":14633,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/posts\/14631\/revisions\/14633"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/media\/14582"}],"wp:attachment":[{"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/media?parent=14631"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/categories?post=14631"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/tags?post=14631"},{"taxonomy":"disease-state","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/disease-state?post=14631"},{"taxonomy":"education-topic","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/education-topic?post=14631"},{"taxonomy":"format","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/format?post=14631"},{"taxonomy":"product-tag","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/product-tag?post=14631"},{"taxonomy":"specialty","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/specialty?post=14631"},{"taxonomy":"technology","embeddable":true,"href":"https:\/\/shockwavemedical.com\/en-eu\/wp-json\/wp\/v2\/technology?post=14631"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}