Application of intravascular lithotripsy in a case of severely calcified arteriovenous fistula stenosis: A case report and technical note.
Aiqiang Zhou, Yafei Zi, Yong Lu et al.
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Case in brief
A patient with a radiocephalic arteriovenous fistula had severe stenosis associated with circumferential calcification, creating a challenge for hemodialysis access maintenance. The lesion was treated with multiple shockwave-balloon impacts using intravascular lithotripsy. The procedure was completed without vascular rupture or dissection, and immediate angiography showed improved stenosis. At 3-month ultrasound follow-up, the lumen remained patent, calcified plaques were reduced, and blood flow velocity had increased from 180 to 420 cm/s.
What made this case unusual
The report describes intravascular lithotripsy for severe circumferential calcification in an arteriovenous fistula, an application the authors note has had limited reporting.
Diagnostic / clinical pearl
In this case, intravascular lithotripsy enabled treatment of a severely calcified fistula stenosis without rupture or dissection, with sustained patency documented at 3 months.
Why it matters
The case supports the feasibility of this approach for complex calcified fistula lesions, while its long-term efficacy remains uncertain.