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. 2025 Jun 1;77(1):53.
doi: 10.1186/s43044-025-00645-z.

Shockwave lithotripsy-assisted TAVI in a patient with severely calcified peripheral arteries and porcelain aorta

Uzeyir Rahimov  1 , Rufat Zeynalov  2 , Emin Karimli  3 , Farid Aliyev  2 , Elkhan Hajiyev  2 , Khatira Abdulalimova  1 , Shafag Mustafaeva  1 , Teoman Kilic  4
Affiliations

Shockwave lithotripsy-assisted TAVI in a patient with severely calcified peripheral arteries and porcelain aorta

Uzeyir Rahimov et al. Egypt Heart J. .

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is the standard treatment for severe aortic stenosis (AS), particularly in high-risk patients. However, peripheral artery disease with extensive vascular calcification poses challenges for transfemoral access. Shockwave intravascular lithotripsy (IVL) has emerged as a promising technique to facilitate vascular access in such cases.

Case presentation: A 73-year-old male presented with non-ST elevation myocardial infarction. His condition necessitated urgent coronary revascularization and later, TAVI for severe AS. Pre-procedural computed tomography angiography revealed severe circumferential calcification of the entire aorta and both iliac and femoral arteries. Due to the extensive calcification and stenosis of the left common iliac artery, IVL was performed to optimize vessel diameter prior to TAVI. Post-IVL, optimal luminal expansion was achieved (6.8 mm), allowing safe passage of the delivery sheath.

Conclusion: IVL-assisted transfemoral TAVI is a safe and effective strategy in patients with extensive iliofemoral calcifications.

Keywords: Aortic stenosis; Lithotripsy; TAVI.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and accompanying images. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Left—Descending aorta and iliac arteries, Right—Porcelain aorta
Fig. 2
Fig. 2
A—Intravascular lithotripsy, B—Diameter of left iliac artery post-intravascular lithotripsy
Fig. 3
Fig. 3
A—Advancement of prosthetic valve through iliac artery, B—Implantation of prosthetic valve
See this image and copyright information in PMC

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