Shockwave IVL: cracking the barriers of below-the-knee disease

Don’t miss this PVI 2025 symposium exploring the role of intravascular lithotripsy (IVL) in below-the-knee (BTK) disease.

The session opens with a clear refresher on how IVL treats both superficial and deep calcium, enabling angioplasty at very low inflation pressures (2–4 ATM). By modifying vessel compliance, IVL helps reduce the risk of dissections while maintaining a strong safety profile, with a low risk of distal embolisation and the possibility to support subintimal recanalisation when required.

The discussion then moves to the key clinical question: when should IVL be used in BTK interventions? Starting from everyday practice, the session reviews plain balloon angioplasty (POBA), a strategy often adopted when scaffolding is not a realistic option for long BTK chronic total occlusions—except in selected cases using the Shockwave E8 catheter. Similar considerations are addressed for BTK bifurcation disease, along with a review of less common but relevant indications.

Finally, a real-life case brings these concepts into practice. Through step-by-step analysis and expert discussion, the session demonstrates how IVL can be a safe and effective option for heavily calcified BTK/BTA lesions, particularly in scenarios where alternative scaffolding solutions are limited. Special attention is given to the new Shockwave E8 catheter, highlighting its improved trackability and ability to treat longer, complex lesions.

A valuable replay for anyone looking to refine BTK revascularisation strategies in the presence of challenging calcium!