Feasibility and Early Results of Peripheral Intravascular Lithotripsy in Heavily Calcified Femoropopliteal Disease: Single-Center Experience.

Background: Intravascular lithotripsy (IVL) is a new endovascular therapy (EVT) for severe femoropopliteal artery calcification. Data from Taiwan are limited.

Methods: Between March 2024 and March 2025, IVL-assisted EVT was performed in six patients (seven limbs, thirteen lesions) with significant femoropopliteal calcification. This study assessed device feasibility, procedural success, vessel patency, clinically driven target-lesion revascularization (CD-TLR), and quality-of-life scores at 12 months using imaging and the EQ-5D-5L.

Results: The average age of the patients was 76 years and they had multiple comorbidities; the baseline ankle-brachial index was 0.61. Most lesions were de novo (77%, mean length 48.5 mm). IVL balloons were deployed at all targets, delivering 153 pulses per lesion. All lesions then underwent specialty balloon treatment, and 77% subsequently received drug-coated balloon angioplasty. EVT reduced stenosis from 81% to 16% and increased lumen area from 2.97 mm²to 26.6 mm². No major complications or bailout stenting occurred. At 12 months, three lesions lost primary patency; one required CD-TLR, and that patient died four months later from intracranial hemorrhage. Quality-of-life scores improved from 0.505 to 0.814.

Conclusions: Early experience with the combined use of IVL, specialty balloons, and drug-coated balloon therapy was encouraging, and this approach may be a promising adjunctive strategy for treating heavily calcified femoropopliteal lesions.