Abstract
Thoracic endovascular aortic repair (TEVAR) is performed with large-bore delivery systems. Small-size access vessels may be a contraindication for TEVAR, particularly in case of severe calcifications. In this case report, we describe the first-in-man use of intravascular lithotripsy to enable transfemoral delivery of TEVAR stent grafts in a patient with severely calcified iliac arteries. A 69-year-old female with multiple sclerosis and thoracic aortic aneurysm (TAA) was referred for percutaneous TEVAR. Both common iliac arteries were severely calcified with circumferential calcifications and a minimum diameter below 5.5 mm. In order to enable percutaneous delivery of 20 French Valiant Navion stent grafts (Medtronic), the circumferential calcified plaques were treated by use of a Shockwave™ Peripheral Intravascular Lithotripsy Balloon (Shockwave Medical Inc.). Subsequently, the aortic stent grafts were safely and successfully passed through the iliofemoral artery and the TAA was excluded by TEVAR. Final angiography showed normal flow in the iliofemoral artery without any signs of perforation or overt dissection. This case report demonstrates successful application of intravascular lithotripsy in calcified iliofemoral arteries enabling percutaneous transfemoral TEVAR. If confirmed in future cases and trials, indications for transfemoral TEVAR may further expand toward patients with severely calcified peripheral arterial disease.
Original language | English |
---|---|
Journal | Catheterization and Cardiovascular Interventions |
Volume | 95 |
Issue number | 3 |
Pages (from-to) | E96-E99 |
Number of pages | 4 |
ISSN | 1522-1946 |
DOIs | |
Publication status | Published - 15 Feb 2020 |
Keywords
- Aged
- Aortic Aneurysm, Thoracic/complications
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/instrumentation
- Catheterization, Peripheral
- Endovascular Procedures/instrumentation
- Female
- Femoral Artery/diagnostic imaging
- Humans
- Iliac Artery/diagnostic imaging
- Lithotripsy
- Peripheral Arterial Disease/complications
- Punctures
- Severity of Illness Index
- Stents
- Treatment Outcome
- Vascular Calcification/complications