{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:31:46Z","timestamp":1786527106938,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":223,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Severe iliofemoral calcification can compromise emergency endovascular control of access\u2010site bleeding by preventing full covered\u2010stent expansion at the landing zone. A 78\u2010year\u2010old man developed hemodynamic instability, right\u2010flank pain, and severe anemia 6\u2009h after ultrasound\u2010guided right transfemoral primary percutaneous coronary intervention for anterior ST\u2010segment elevation myocardial infarction. Contrast\u2010enhanced computed tomography demonstrated a large right retroperitoneal hematoma with active extravasation from the distal external iliac artery, immediately proximal to a bulky calcified plaque involving the proximal common femoral artery (CFA). Through ultrasound\u2010guided contralateral femoral access, an 8\u2009mm\u2009\u00d7\u200960\u2009mm self\u2010expanding covered stent achieved immediate sealing of the external iliac artery injury but remained markedly underexpanded distally at the calcified CFA landing zone. Conventional 8\u2010mm balloon post\u2010dilation was attempted, but residual underexpansion persisted; further high\u2010pressure dilation was avoided because of concern for rupture or perforation of the calcified iliofemoral segment and loss of the newly achieved seal. Bailout intravascular lithotripsy (IVL) with an 8\u2009mm\u2009\u00d7\u200960\u2009mm balloon consisted of 150 pulses delivered at 4\u2009atm in repeated sequences, each followed by nominal\u2010pressure post\u2010dilation of the same balloon at 6\u2009atm. Final angiography showed improved covered\u2010stent expansion with approximately 30% residual stenosis and no recurrent extravasation, dissection, perforation, or distal embolization. The patient was discharged on postoperative day 8. At 12\u2010month follow\u2010up, duplex ultrasound confirmed covered\u2010stent patency without edge stenosis, pseudoaneurysm, or hemodynamically significant restenosis. This case illustrates that IVL may provide a low\u2010pressure bailout option for calcium\u2010mediated peripheral covered\u2010stent underexpansion during emergency vascular access\u2010site repair; however, this off\u2010label use requires careful device sizing, attention to covered\u2010stent integrity, and structured imaging surveillance.<\/jats:p>","DOI":"10.1155\/cris\/4893296","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T08:48:11Z","timestamp":1786524491000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bailout Intravascular Lithotripsy for Calcium\u2010Mediated Underexpansion of a Peripheral Covered Stent in an Emergency Setting: A Case 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