Peripheral artery disease (PAD) affects millions of people, especially those over 60. It occurs due to the buildup of plaque in the arteries, leading to narrowing and hardening of the blood vessels, which impairs circulation. PAD can cause pain in the legs when walking (claudication) and increase the risk of severe complications such as critical limb ischemia, non-healing ulcers, and even amputation. About 6.5 million people over age 40 in the U.S. have PAD.
Heavily calcified blood vessels pose significant challenges to traditional treatments like angioplasty and stenting. Intravascular lithotripsy offers a novel approach to address these difficult cases.
What is Intravascular Lithotripsy?
Intravascular lithotripsy (IVL) is a minimally invasive procedure designed specifically to treat severely calcified arteries. This technology adapts the principles of kidney stone treatment (urological lithotripsy) for use within blood vessels. IVL uses sonic pressure waves to selectively fracture calcium deposits while preserving the integrity of surrounding blood vessels.
The procedure was first approved by the FDA for peripheral arterial disease in 2016, with approval for coronary applications following in 2021. This is game-changing technology that allows us to treat patients who previously had no options or had to have invasive surgery. Unlike more aggressive calcium-modification techniques, IVL offers a gentler approach that minimizes trauma to the vessel wall while effectively addressing the challenging calcium deposits that can impede successful angioplasty and stenting.
How does it work?
Intravascular lithotripsy works through a very straightforward yet effective mechanism:
Anesthesia
The procedure is performed with local anesthesia, and patients are usually awake, although they may receive some sedation.
Catheter placement
A specialized balloon catheter equipped with lithotripsy emitters is guided to the calcified segment of the artery using X-ray guidance. This is done through a small puncture, typically in the groin, similar to other catheter-based procedures.
Balloon inflation
The balloon is partially inflated at low pressure to ensure the emitters contact the vessel wall. This strategic positioning maximizes the effectiveness of the energy delivery while minimizing the risk to surrounding tissues.
Energy delivery
Once positioned, the system delivers pulsatile sonic pressure waves (similar to ultrasound but at higher energy) that create a series of microfractures in the calcium deposits. These sonic waves are generated by emitters within the balloon that convert electrical energy into acoustic energy.
Calcium disruption
These pressure waves selectively impact the hardened calcium while sparing the surrounding elastic tissue. The calcium cracks into smaller fragments, allowing the artery to expand more easily. This selective fragmentation is a key advantage of IVL technology.
Final dilation
After the calcium is fractured, the balloon can be fully inflated at normal pressure to open the artery, often followed by stent placement to maintain vessel patency. The now-fractured calcium offers significantly less resistance, allowing for optimal stent expansion.
Imaging evaluation
After the procedure, advanced imaging techniques like Intravascular Ultrasound (IVUS) are used to check how well the treatment worked. These tools help determine if the calcium in the artery has been successfully broken up and if the artery is now more open.
Recovery and follow-up
Most patients can return home the same day, with minimal restrictions on their activities compared to more invasive surgical alternatives. Follow-up appointments are scheduled to monitor the patient’s progress and ensure proper healing.
Potential risks and complications
Like any medical procedure, intravascular lithotripsy carries some risks. Rare complications include vessel injury, bleeding, or temporary blood pressure changes during the procedure.
Who is a Candidate for Intravascular Lithotripsy?
IVL is ideal for patients with severe arterial calcification, which makes traditional angioplasty or stenting less effective. This treatment is especially beneficial for:
- People with coronary artery disease who have hardened, calcified blockages that are difficult to treat with standard methods.
- Patients whose previous procedures have failed due to rigid, difficult-to-remove calcium buildup.
- High-risk patients who aren’t good candidates for more invasive surgeries.
- Those with calcified blockages in complex areas, like small vessels or branch points, where conventional treatments may not work well.
Additionally, IVL is a highly effective option for calcification of arteries treatment, providing relief for individuals with PAD who experience symptoms like:
- Aching or cramping
- Heaviness
- Swelling
- Fatigue
- Restless legs
- Skin changes
- Open wounds or sores
The versatility of IVL makes it a valuable option for patients experiencing these symptoms, particularly when traditional treatments have proven ineffective or too risky.
Benefits of Lithotripsy for Artery Health
IVL offers several advantages over traditional angioplasty, especially in treating calcified arteries. These benefits include:
- Enhanced safety: IVL minimizes the risk of arterial dissection or perforation, which are common complications associated with high-pressure balloon angioplasty.
- Improved outcomes: By effectively fracturing calcium deposits, IVL allows for better artery expansion and stent deployment, leading to improved blood flow and reduced risk of restenosis.
- Minimally invasive: The procedure is performed through a small catheter insertion, resulting in less discomfort and faster recovery compared to open surgical procedures.
- Reduced complications: IVL’s ability to selectively target calcium reduces the risk of damage to surrounding tissues, leading to fewer complications.
- Effective in complex lesions: IVL is very effective in treating heavily calcified lesions, which are often challenging to manage with other techniques.
- Faster recovery: Many patients can go home the same day as their procedure, with recovery times typically shorter than those associated with more invasive surgical alternatives like bypass surgery.
- Improved quality of life: By improving blood flow, IVL reduces symptoms such as pain, cramping, and fatigue.
Potential risks and complications of IVL include:
- Distal embolization
- Access site bleeding/hematoma
- Infection
- Vessel spasm/slow-flow
- Vessel injury
- Arterial dissection or rupture
IVL has been shown to have high success rates and promising long-term outcomes in treating calcified coronary lesions.
When to Consult a Doctor
If you experience any of the following symptoms, you should consider consulting a vascular surgeon:
- Leg pain, cramping, or fatigue during walking that improves with rest (claudication)
- Numbness or weakness in the legs
- Slow-healing wounds on the legs or feet
- Cold or discolored extremities
- Decreased pulse strength in the legs or feet
- Chest pain or shortness of breath
- Decreased ability to perform regular activities due to pain or fatigue
- Sudden worsening of any existing symptoms
Empire Vein & Vascular Specialists is the region’s only vascular surgery group offering advanced IVL technology for PAD, treating severe calcification through minimally invasive procedures. We also provide comprehensive guidance on cutting-edge treatment options and accept most insurance plans.
For more information about Intravascular Lithotripsy or to schedule a free vein screening, contact Empire Vein & Vascular Specialists at 1.800.VARICOSE (1-800-827-4267).