Key result
Peripheral intravascular lithotripsy enables safe transfemoral TAVR in severe aortoiliac calcification without vascular complications.
Why the study?
Severe iliofemoral calcific atherosclerosis can preclude transfemoral TAVR, and intravascular lithotripsy fractures calcium to increase vessel compliance and enable transfemoral access.
Does peripheral intravascular lithotripsy enable safe and successful transfemoral transcatheter aortic valve replacement in a patient with severe calcific aortoiliac stenosis?
Case Report (n=1)
Does peripheral intravascular lithotripsy enable safe and successful transfemoral transcatheter aortic valve replacement in a patient with severe calcific aortoiliac stenosis?
Peripheral intravascular lithotripsy is an effective strategy to modify severe iliofemoral calcifications, facilitating standard transfemoral TAVR in patients who would otherwise require higher-risk alternative access routes.
Background: The presence of severe calcific atherosclerosis at the iliofemoral axis may preclude transcatheter aortic valve replacement (TAVR) by the transfemoral (TF) approach. Intravascular lithotripsy (IVL) is a novel technology that fractures intimal/medial calcium, increasing vessel compliance and enabling TF-TAVR in selected patients with peripheral artery disease. Case summary: A 76-year-old female presented with severe degenerative calcific aortic valvular stenosis. The patient was planned for TAVR due to high surgical risk status. However, computed tomography analysis revealed significant aortoiliac calcific narrowing, which limited TF access. Intravascular lithotripsy was performed to modify the calcific stenosis in the aortoiliac region, after which TAVR was successfully completed via the transfemoral route. This intervention was crucial in allowing TAVR to be performed at a low risk. The procedure was successful, and the patient was doing well at 8-month follow-up. Discussion: Peripheral IVL appears to be a safe and effective solution for TAVR candidates with co-existing iliofemoral calcifications. Using peripheral IVL to facilitate TF access should be part of the TAVR algorithm, to maintain the safety profile and superior outcomes of traditional TF-TAVR. More research is needed to improve the understanding of anatomical selection for IVL in TAVR candidates. Operators performing IVL-assisted TF-TAVR should be familiar with endovascular interventions and bailout solutions, not so much to treat IVL-treated lesions, but to be able to treat any vascular complication that may occur at the puncture site.
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Bhastana et al. (2025) conducted a case report in Severe calcific aortic stenosis with severe aortoiliac calcification (n=1). Peripheral intravascular lithotripsy (IVL) was evaluated on Procedural success (TAVR deployment and freedom from vascular complications). Peripheral intravascular lithotripsy successfully modified severe aortoiliac calcific stenosis, enabling safe transfemoral transcatheter aortic valve replacement without vascular complications.
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