Safety and Short-Term Efficacy of Intravascular Lithotripsy for Treatment of Peripheral Arterial Disease: A Systematic Review

Abstract

AbstractIntravascular lithotripsy (IVL) is an emerging treatment for calcifications in patients with peripheral arterial disease (PAD). The objective of this article is to evaluate the safety and efficacy of IVL for PAD management by performing a systematic review of existing literature. A systematic literature search was performed using the PubMed database. A literature search was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Outcomes variables analyzed in each study include preprocedure ankle–brachial index, preprocedure lesion length, preprocedure calcified length, preprocedure diameter stenosis, average number of IVL pulses, success rate, adjunctive treatments given, postprocedure diameter stenosis, acute vessel gain, and specific complications. Three-hundred fifty-seven articles were reviewed on PubMed and 14 studies were ultimately included, comprising 857 patients and 991 lesions. Thirteen of the 14 studies reported a 100% procedural success rate. Mean preprocedure lesion length was 68.94 (20-103.4) mm and mean preprocedure calcified length was 86.5 (50.5–140.9) mm. The average preprocedure diameter stenosis was 77.44% and postprocedure diameter stenosis was 26.14%. All studies reporting both pre- and postprocedure diameter stenosis stated there was a significant reduction in the vessel diameter stenosis and acute gain following IVL therapy alone. About 8.2% of patients had reported dissections and 0.29% had perforations. There was no reported distal embolization, thrombus formation, or abrupt closure of the vessel in any study. IVL appears to be a safe and effective treatment for calcified lesions in patients with PAD, with a low rate of complications and successful luminal gain for most lesions. Further prospective studies are needed to help validate the effectiveness of IVL therapy.