Treatment of symptomatic CMI is widely accepted to prevent acute mesenteric ischemia. There is no documentation on the use of IVL in the treatment of atherosclerotic disease presenting as mesenteric ischemia. Open surgical repair has survival rates of approximately 80% to 90% (Lejay et al. 2015). Intravascular treatment has become an alternative to open surgery. One study showed that although primary patency rates were below 45%, secondary patency rates were comparable to 94%. The presence of highly calcified ostial occlusions represents an important limitation of endovascular interventions (Van Petersen et al. 2010).
The Shockwave Lithoplasty® System IVL consists of three components: the balloon catheter for performing the IVL, the connecting cable for pulse therapy, and a power generator. The IVL catheter consists of an OTW balloon catheter, which has, inside, several emitters of sonic shock waves whose diffusion generates a pressure of 50 atm. Activation of the device applies pulsed mechanical energy transmitted in the form of shock waves that pass through soft tissue without altering it and without causing damage to the vessel. Upon reaching the calcified plaque, the transmitted energy generates microfractures, modifying the calcium and therefore the morphology of the artery, allowing a posterior dilation with the balloon at low pressure (6 atm).
The application of IVL technology has been reported in coronary and peripheral endovascular procedures, including the iliac, femoral, and renal arteries. Currently, several multicenter studies are being conducted to evaluate the safety (DISRUPT CAD II) and efficacy (DISRUPT CAD / PAD III) of IVL in the coronary and peripheral territories (Adams et al. 2020; Brinton et al. 2019; Brodmann et al. 2017; Armstrong et al. 2020). The first studies on its peripheral use show promising results confirming a patency of 100% after 30 days, 70–80% at 6 months and 54–70% at 12 months, with a 95% clinical success rate, indicating less than 50% residual stenosis after the procedure with no evidence of acute adverse cardiac events, embolizations, thrombus formations, or perforations (Brinton et al. 2019; Brodman et al. 2019).
This report with the application of IVL therapy demonstrates successful revascularization in lesions that combine calcium thickness and a large calcium arc (270° of the vessel circumference), making dilation difficult with conventional therapy.