Intravascular Lithotripsy for Coral Reef Aorta and Chronic Mesenteric Ischemia: Case Report and Comprehensive Literature Review.

Abstract

Chronic mesenteric ischemia (CMI) secondary to extensive paravisceral atherosclerosis is a rare but challenging vascular condition, often presenting with postprandial abdominal pain, weight loss, and claudication due to impaired blood flow. While surgical bypass is a standard treatment, it carries significant risks, particularly in patients with severe calcified vascular disease. Advances in endovascular techniques, including intravascular lithotripsy, offer less invasive alternatives for select cases. We describe the application of IVL in a patient with near-total paravisceral aortic occlusion involving the origins of the superior mesenteric, celiac, and bilateral renal arteries. A multidisciplinary endovascular-first approach integrated IVL, angioplasty, and embolic protection, abolishing the translesional gradient and restoring visceral and renal perfusion. One-year follow-up confirmed durable patency and symptom resolution. To contextualize this case, we reviewed published reports of IVL in visceral and paravisceral disease, which collectively demonstrate high technical success, symptomatic improvement, and acceptable short-term safety, though long-term durability data remain limited. This case illustrates the effective use of endovascular lithotripsy for extensive paravisceral atherosclerosis causing CMI. This paper adds to emerging evidence supporting the role of IVL in complex mesenteric and paravisceral interventions.