Shockwave Lithotripsy-Assisted TAVI in a Patient with Severely Calcified Peripheral Arteries and Porcelaine Aorta

Background: Transcatheter aortic valve implantation (TAVI) is the standard treatment for severe aortic stenosis (AS), particularly in high-risk patients. However, peripheral artery disease (PAD) with extensive vascular calcification poses challenges for transfemoral access. Shockwave Intravascular lithotripsy (IVL) has emerged as a promising technique to facilitate vascular access in such cases. Case presentation: A 73-year-old male presented with non-ST elevation myocardial infarction (NSTEMI). His condition necessitated urgent coronary revascularization and later, TAVI for severe AS. Pre-procedural computed tomography (CT) angiography revealed severe circumferential calcification of the entire aorta and both iliac and femoral arteries. Due to the extensive calcification and stenosis of the left common iliac artery, IVL was performed to optimize vessel diameter prior to TAVI. Post-IVL, optimal luminal expansion was achieved (6.8mm), allowing safe passage of the delivery sheath. Conclusion: IVL-assisted transfemoral TAVI is a safe and effective strategy in patients with extensive iliofemoral calcifications.