1Hashem Barakat,1Sanjay Patel, 1Hany Zayed

1Guy’s and St Thomas’ NHS Foundation Trust


Vessel preparation is important before definitive endovascular treatment of heavily calcified infrainguinal lesions in patients with Chronic Limb Threatening Ischaemia (CLTI). Our aim is to describe our approach and present our outcomes with different vessel preparation modalities: Intravascular lithotripsy (IVL) and Atherectomy.

Material(s) and Method(s):

This was a retrospective review of last years’ experience from a large tertiary referral centre in London, UK. Consecutive patients undergoing endovascular revascularisation for CLTI between January 2021 and January 2022 were screened. All those who underwent vessel preparation with plain balloon angioplasty (POBA), IVL or Atherectomy were included in this study. The main outcome measure was freedom from clinically driven target vessel revascularisation (TLR) at 3 and 6 months.


A total of 90 procedures on 84 patients are included. All patients presented with CLTI.

We compared the outcomes between the group undergoing POBA (44 limbs) and the group undergoing Atherectomy or IVL (46 limbs). The two groups were similar in most baseline characteristics, severity of presentation and anatomical staging of disease burden.

At 3 months, 11 patients from the POBA group required reinterventions, compared to 2 patients in the Atherecomy/IVL group (p=0.005). The trend was similar at 6 months; 15 patients in the POBA group required reintervention compared to 5 in the Atherectomy/IVL group (p=0.008).


This study demonstrates favorable early outcomes when Atherectomy or IVL are used as vessel preparation techniques in patients with CLTI due to infrainguinal arterial disease.