Intravascular Lithotripsy of Negatively Remodeled Calcified Abdominal Aorta to Facilitate Transfemoral Transcatheter Aortic Valve Replacement.

backgroundTransfemoral access is the preferred route for transcatheter aortic valve replacement (TAVR), but severe calcification and luminal narrowing of the iliofemoral artery or abdominal aorta may preclude safe large-bore sheath passage. Intravascular lithotripsy (IVL) has been increasingly used for iliofemoral vessel preparation, yet its application in the abdominal aorta has been rarely reported. CASE SUMMARY: An 84-year-old woman with symptomatic severe aortic stenosis was deemed high risk for transfemoral TAVR owing to severe narrowing with circumferential calcification of infrarenal aorta with luminal diameter <5 mm. To preserve transfemoral access, IVL with a 7.0-mm Shockwave balloon was performed using stepwise low-pressure inflations (1-6 atm, 300 pulses), achieving adequate luminal expansion for an 18-F sheath. A 23-mm self-expanding valve was successfully implanted without complications, and the patient was discharged the next day. DISCUSSION: This case demonstrates that IVL can safely modify a small-caliber, circumferentially calcified iliofemoral and abdominal aorta to facilitate transfemoral TAVR. TAKE-HOME MESSAGE: Stepwise low-pressure inflations and meticulous procedural planning may expand the feasibility of transfemoral access in patients otherwise considered for higher-risk alternative routes.