Interventional procedure overview of intravascular lithotripsy for calcified arteries in peripheral arterial disease

Indications and current treatment

Peripheral arterial disease (PAD) is caused when a build-up of fatty substances (plaque) in the arteries restricts blood supply to the limbs, usually the legs. The plaque can calcify and become like bone. This is known as intravascular calcification, and it is particularly common in people with diabetes mellitus or chronic kidney disease. The most common initial symptom of PAD is leg pain while walking, known as intermittent claudication. If blood flow is severely restricted, chronic limb-threatening ischaemia (CLTI, also known as critical limb ischaemia) can develop. Symptoms include severe pain at rest, ulceration or gangrene. CLTI is associated with a high risk of amputation and death, and the presence of arterial calcification increases these risks.

Management of PAD is described in NICE's clinical guideline on peripheral arterial disease. For CTLI, revascularisation using percutaneous transluminal angioplasty (with or without stent placement) or a bypass graft is recommended. Atherectomy devices that vaporise, cut or grind away plaque within the artery, are sometimes used alongside angioplasty. If revascularisation is not an option, major amputation may be offered.