CLTI: Lithotripsy & Endovascular Techniques for Below the Knee Interventions

Dr. Foley begins by outlining his training and the evolution of his vascular surgery practice, setting the stage for a broader discussion on how BTK interventions have changed over the past decade. The conversation explores shifts in access strategies, procedural approaches, and the unique characteristics of calcification encountered in CLTI. Because BTK calcium differs from calcification seen elsewhere in the peripheral vasculature, imaging and device selection play a particularly important role when planning IVL-based therapies. Dr. Foley reviews the design and outcomes of the Disrupt BTK II trial, where devices such as the Shockwave M5+ and S4 catheters were used to modify calcified plaque, demonstrating encouraging safety and performance signals.

The discussion then turns to emerging technologies, including Shockwave’s Javelin catheter, designed to deliver focused pressure waves to fracture dense calcium within peripheral arteries. Dr. Foley describes how the device fits into BTK workflows, including technique considerations and its use alongside adjunctive therapies such as balloon angioplasty. The episode also addresses the ongoing skepticism surrounding IVL in BTK disease, emphasizing the need for careful patient selection, procedural precision, and continued multidisciplinary collaboration as the field works to refine treatment strategies and improve outcomes for patients with peripheral artery disease (PAD).