Contemporary Role of Intravascular Lithotripsy in the Management of Peripheral Artery Disease

Purpose of review Calcified peripheral arterial disease (PAD) poses a significant challenge to endovascular treatment. Traditional balloon angioplasty in these restrictive lesions often leads to suboptimal vessel expansion and thereby increased rates of restenosis and complications. Although several calcium-modifying and debulking technologies have been developed to help optimize management of these complex lesions, they have their own limitations. Recently, intravascular lithotripsy (IVL) has been established as an alternative versatile modality for treating a variety of lesions with minimal adverse events. Herein, we undertake a review of the currently available literature to further assess the safety and efficacy of IVL in PAD. Recent findings DISRUPT PAD I, II, III, and BTK are dedicated global clinical trials undertaken to study the safety and efficacy of IVL in calcified PAD. Their results demonstrated significant improvement in lumen gain and low rates of adverse events. Summary IVL is an innovative modality developed to improve the treatment success of calcified PAD with a favorable safety and efficacy profile across multiple clinical studies. Further larger scale studies are warranted to confirm durability of these results and directly compare IVL against presently available calcium-modifying agents.